Cross-Cultural Counselling Problem Solver
The purpose of this tool is to help mental health practitioners to explore and evaluate strategies they may wish to use to enhance their work with culturally diverse clients. This document is adapted from "An inventory for enhancing cross-cultural group work"1, which is based on an extensive literature review, and grounded in the Psychotherapy Adaptation and Modification Framework2.
Practitioners are advised to employ these recommendations only in combination with their best clinical judgment, consideration of a client’s individual characteristics and preferences, as well as with in-depth knowledge of the client’s specific cultural group. For more information on the various strategies, please consult the publications and PowerPoint workshops on the resources page.
Suggested Citation: Rapacki, T. M., & McBride, D. L. (2017). Cross-Cultural Counselling Problem Solver. Retrieved from http://www.culturedpsychology.com/cultural-problem-solver/
I want to...
Respond more effectively to client cultural beliefs.
Take a Holistic, Psychoeducational Approach
- Teach and utilize a biopsychosocial model of mental illness2
- Maintain a more systemic focus28
- Help resolve relational/social conflicts4,6
- Explore the consequences of interventions for the client’s family29
- Simplify material, reduce learning load, consolidate complex topics6
- Consider increasing session length; teaching time for unfamiliar concepts6
Use Cultural Bridging Techniques
- Use a traditional wellness model from the client’s culture such as Yin & Yang7 or the Medicine Wheel30-32 to present mental health strategies
- Utilize the wheel of wellness33
- Learn and make use of cultural sayings to explain therapeutic concepts2,34-36
- Frame interventions so as to be congruent with specific cultural values7,36
Incorporate Client Cultural Beliefs, Strengths, and Resources
- Increase focus on resolving relational problems6
- Assess social/familial/environmental contributions to illness and wellness4
- Emphasize collaboration over confrontation4
- Teach problem-solving for coping with practical environmental stressors4
- Present skills together with cultural context within which they will be effective4
- Refocus hierarchical, punitive cultural parenting styles on harmonious collectivist values37
- Reframe familial conflict as differences in acculturation and offer assistance as a cultural broker38
- Educate about Acculturative Family Distancing and mental health39,40
- When acculturation conflicts occur in families, consider reframing acculturation as development of bi-cultural competence, not assimilation
- Emphasize help-seeking as finding solutions rather than admitting failure41
- Encourage culturally-congruent and inexpensive self-care activities4,2
- Conduct a cultural strengths/assets search4
- Be aware of possible differences in values such as sharing vs. individual achievement, non-interference42, dialectical/negotiated problem resolution43,44
Minimize Perceived Stigma and Shame of Receiving Counselling
- Increase collaboration with cultural healers, doctors, elders, religious leaders, and other physical/spiritual health practitioners2
- Increase visibility in the cultural community45
- Distribute materials and raise awareness where clients first seek help45
- Address community misconceptions about mental health services45
- Stress privacy and confidentiality46
- Decrease emphasis on changing cognitions; increase positive thinking, problem solving, and behavioral activation4,6
- Question the helpfulness rather than rationality of a problematic beliefs, particularly when stressors are real4
Structure therapy to be more effective.
Provide an Adequate Orientation to Therapy
- Make time for a longer, more detailed orientation2,6
- Educate explicitly about roles and expectations in therapy2,6
- Explain the typical course of treatment2
- Build rapport by emphasizing confidentiality19
- Discuss healthy termination to reduce dropout2
- Reduce stigma by articulating a holistic/biopsychosocial model that doesn’t make clients feel personally blamed for their illnesses and struggles2,4
Respond to Client Expectations
- Assess if the client may prefer a more active, problem-focused, and expert approach19-27
- Discuss with clients how needing extra time to acclimatize to a foreign therapeutic culture and having waited longer to seek help may slow initial therapeutic benefits6
- Offer the gift of a small solution early on as an example, and for motivation5
Establishing Goals and Structure
- Emphasize co-constructing19 therapy and interventions
- Consider establishing frequent goals and markers of treatment progress with periodic review6
Improve my relationship with my client.
Develop Your Own Cultural Knowledge/Self-Awareness
- Read about clients’ cultural backgrounds
- Inquire directly about cultural values and influences
- Expose self to different cultures
- Explore Hofstede’s cultural dimensions for a client’s culture47,48
- Take cultural workshops, coursework, supervision, and consultation; diversify caseload49
- Utilize a White50/ethnic14 identity model to guide own cultural development
Improve Joining With the Client
- Utilize proper cultural etiquette in initial sessions6
- Offer tea; show concern about client’s physical comfort; increase self-disclosure6
- Discuss/assess family and immigration history as an icebreaker2
- Normalize client feelings/perceptions of stigmatization6
- Actively provide validation, praise, emotional support, validate difficulty of sharing6
- Convey alignment nonverbally, e.g. moving one’s chair to sit alongside a client while addressing a list of current problems51
Promote Realistic Expectations
- Explicitly discuss roles and expectations6,2
- Appear more professional; consider being more proactive with giving advice7 if this matches client expectations
- Be aware of transference of expectations: e.g. a doctor, healer, or priest52
- Facilitate development of realistic expectations2
- Be aware that more severe problems may be possible due to delaying treatment due to cultural stigma of mental health help-seeking2
- Begin with easier tasks to inspire confidence4
- Share anecdotes or cases that normalize help-seeking, reduce feelings of isolation, or normalize initial difficulties6
Be an Ally Against Racism and Prejudice
- Actively broach the topic of race and racism in sessions53
- Anticipate mistrust4
- Strongly consider validating any feelings of victimization4,53
- Validate racial microaggressions54,55 as real and hurtful
Utilize "Cognitive Matching" in Your Discussions
- Generally avoid challenging cultural beliefs unless this is a client goal4
- Use cognitive matching: match responses, discussions, and interventions to individual, sociocultural, or universal levels by following client language56
Understand and assess my clients more effectively.
Understand Non-Western Self-Esteem
- Include interdependent traits3 in self-esteem building
- Inquire about group membership when assessing self-esteem
- Ask the question “what would your mother (friend, etc.) say are your personal strengths?”4
Respond to Acculturation Level and Personal Values
- Use clients’ level and strategy of acculturation to inform how to “size”5,6 cultural interventions
- Personalize statements recognizing clients’ cultural values without stereotyping6
- But, discuss common cultural experiences if doing so normalizes stigmatized experiences or emphasize the customization of a counseling program7
- Assess acculturation formally e.g. through the GEQ8, VIA9, AVS10, etc.11,12
- Assist a client with finding and employing a comfortable acculturation13 strategy
- Ask clients about the role of culture and context in their lives when unsure of how to dynamically size interventions
Consider Minority Identity Development
- Utilize a model of minority identity development14 to set developmental goals when appropriate
Consider Personality in Context
- Reduce the weighting of personality assessment conclusions based on limited cultural norms
- Interpret personality in the context of national differences15,16 in mean scores
- Consider that newcomer “neuroticism” may simply reflect acculturative stress17
- Learn about and use indigenous personality tests, such as the CPAI-218
- Discuss indigenous personality values and concepts with your participants
Adapt to Differences in Communication
- Consider using silence to demonstrate understanding in initial sessions4
- Avoid misinterpreting normal low-key, indirect communicative behavior as passivity, avoidance, or shyness, if such communication is a cultural trait2
- Allow Aboriginal persons ample time to finish speaking57
- Be aware of differences in meaning of smiles, silence, and eye contact19,58
- Increase self-disclosure19,58-62, invitational body language64; invite questions19
- Employ visuals, translators, supportive friends or family members, multilingual dictionaries64
- Be mindful of the ethical limitations of using child translators19
- Apologize for the limitations of one’s cultural helping style but express a willingness to understand the clients and their situations65
- Utilize homework evaluation forms66; translated exit/feedback slips (i.e. SRS67 and ORS68)
- Discuss the cultural meaning of interpersonal distance58
Understand Expressions of Distress
- Focus part of early assessment on physical symptoms2
- Inquire about psychosocial symptoms indirectly: “Dealing with headaches and dizziness can be quite troublesome; how are these affecting your mood, relationships, etc.?”69
- Help clients differentiate between thoughts and feelings during treatment6
- Use a non-stigmatizing procedure to make a co-diagnosis with a client7
Further refine my services for a client and their cultural group.
Educate Yourself on Specific Cultural Issues
- Take the initiative to learn about the strengths and challenges of individual cultural groups2
- Adopt an expanded understanding of responsibilities as a mental health worker70,71
- Assist/counsel clients on meeting practical needs, overcoming structural barriers4,68-73
- Use the Three Dimensional Model of Multicultural Counseling70
- Consult with the community or community leaders on adapting your counseling approach6,7
- Utilize the FMAP6 or Cultural Adaptation Process Model74 to incorporate community feedback into therapeutic modifications
1 Rapacki, T. M., & McBride, D. L. (2015). An inventory for enhancing cross-cultural group work. In W. Pelech, K. Ring, & S. LaRocque (Eds.), Unity in Diversity: Embracing the Spirit of Group Work: Proceedings of the XXXVI Annual Symposium of the International Association of Social Work With Groups (pp.202-219). London: Whiting & Birch.
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51 Thornton, as cited in Hays4 (p.375)
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