Self-Assessment: Cultural Issues as a Lens in Accessing Clinical Services

1. Self-Assessment: Cultural Issues as a Lens in Accessing Clinical Services Loretta Braxton Ph.D., Durham and the Multicultural & Diversity Committee (2009-2010) VA Psychology Training Council Contact persons: Daryl Fujii Ph.D., Honolulu (Daryl.Fujii@va.gov) Rachael Guerra Ph.D., Palo Alto (Rachael.Guerra@va.gov)

2. Multicultural/Diversity Committee Committee 2009-2010 Loretta E. Braxton Ph.D., Durham, (Co-Chair) Linda R. Mona Ph.D., Long Beach (Co-Chair) Lenora Brown Ph.D., St. Louis Daryl Fujii Ph.D., Honolulu Rachael Guerra Ph.D., Palo Alto Jamylah Jackson Ph.D., North Texas Tina Liu-Tom Ph.D., Honolulu Monica Roy Ph.D., Boston Miguel Ybarra Ph.D., San Antonio Jay Morrison Ph.D., San Francisco (Postdoc) Velma Barrios, Greater Los Angeles (Intern)

3. Overview • Introduction • Learning Objectives • APA Statement on Culturally Relevant Clinical Services • Self Assessment • Case Vignettes and Exercises • Group Discussion • Summary and Conclusion • References

4. Learning Objectives • Acquire self-knowledge regarding your thoughts, feelings and experiences and how they may impact your work re diversity • Inspire development of personal learning objectives and action plans regarding strengths and weakness around diversity as it relates to your work

5. Self Assessment and APA Multicultural Guidelines “…the population of the United States is racially/ethnically diverse, and that students, research participants, clients and the workforce will be increasingly likely to come from racially/ethnically diverse cultures.” APA Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists (2003)

6. Self Assessment Our job is to offer the best care possible within the context of a fluid standard of care; this is a standard that evolves as we are presented with more, and new, research and information.

7. Importance of self assessment • Better understanding of ourselves • What are your limits? • Better understanding of how who we are impacts the work that we do. • What are you afraid will happen that will take you out of your limits? • The process of getting off automatic • What can you do about it?

8. Positive attributes of people who are willing to directly address diversity issues • Resilience • Belief in what you are doing • Cognitive flexibility • Understanding of issues • Positive Outlook • Sincerity • Sensitive to people’s needs and concerns • Walk the talk Clements & Jones (2006)

9. Activities That Can Promote Self-Examination • Low Risk • Case discussions (Nile, 2008) • The Zax (Dr. Seuss, 1989) • What does it mean to ? • Moderate • Racial micro-aggression article (Sue et al, 2007) • The Color of Fear movie (Wah, 1994) • High Risk • White Privilege: Unpacking the Invisible Knapsack (McIntosh, 1988)

10. The Zax "The Zax" is a story about the importance of compromise. There is a North-going Zax and a South-going Zax who meet face-to-face in the Prairie of Prax. The two stubborn Zax refuse to move east, west, or an inch except where they are standing. The Zax become stuck, as they refuse to move around each other declaring to stand there for 59 days or better yet, 59 years! Eventually a highway overpass is built around them. The story ends with the Zax standing in their respective places. “Never budge in the least." Dr. Seuss (1989)

13. Micro-Affirmations and Micro-Inequities • Micro-Messages are small, unspoken and often unconscious messages that are constantly sent and received that have a powerful impact on our interactions with others. • Micro-Affirmations are micro-messages that convey inclusion, respect, trust and a genuine willingness to see others succeed. • Micro-Inequities are negative micro-messages that are small events, subtle acts of disrespect, which are hard to prove, covert and often unintentional.

14. Racial Micro-Aggressions Racial micro-aggressions are brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults toward people of color. Sue et al. (2007)

15. Forms of Micro-Aggression • Micro-assault • Explicit racial derogation conducted on an individual level (e.g., calling someone colored, Oriental, • Usually expressed in safe, private situations (e.g., expressing opinions re the races should never mix while presenting another view publicly) • Micro-insult • Subtle interactions/communications that convey rudeness and insensitivity • Verbal or non-verbal • Micro-invalidation • Communications that exclude, negate or nullify the psychological thoughts, feelings, or experiential reality of the person of color

16. White Privilege • I can, if I wish, arrange to be in the company of people of my race most of the time. • I can be pretty sure of having my voice heard in a group in which I am the only member of my race. • Whether I use checks, credit cards or cash, I can count on my skin color not to work against the appearance of my financial stability. • I can do well in challenging situations without being called a credit to my race.

17. If I declare there is a racial issue at hand, or there isn’t a racial issue at hand, my race will lend me more credibility for either position than a person of color will have. • I am not made acutely aware that my shape, bearing or body odor will be taken as a reflection on my race. • I can expect figurative language and imagery in all of the arts to testify to experiences of my race. • I can travel alone or with my spouse without expecting embarrassment or hostility in those who deal with us.

18. Managing hot buttons • Share your experiences with others. • Be willing to admit when you don’t understand or agree with an issue or focus • Use humor but sparingly. Self-deprecating humor is usually acceptable. • Keep an open mind.

19. Managing Personal Hot Buttons • Become vulnerable and open to self-inspection. • Take two deep breathes before responding. • Acknowledge comments by using “I statements”: for example, “I hear what you are saying. Let me share with you my thoughts on that.” • Be honest with yourself about your own “hot buttons.” You may say something similar to “That’s an issue I’ve thought about a lot. Let me share some of my thoughts about it with you.” • If something is highly offensive, take a step back and acknowledge it. “I’m really shocked by that statement. I need a second to think about that.”

20. A little self examination • Why this reaction? • Would someone from a different background take a different view? Why? • What does this reaction say about me, my values, my beliefs, my attitudes? • How open am I to being challenged?

21. Discussion questions • The identities I’m most conscious of… • What this means for me on a day to day basis.. • A time that I felt excluded because of who I am… How I felt and what I did… • A time that I’ve participated in treating others as less than, How did I feel and what did I do? • The parts of my identity I’ve done the least amount of work around include… Washington, 2009

22. Case Vignette A 22 year old male comes to your clinic for treatment. He is over six feet tall, weighs two hundred pounds, and is very dark-skinned. The patient is a recovering substance abuser. He is withdrawn and often stares intently at the staff and at other patients. The clinic staff talk about his “scary” stare and the word gets around that he should be “watched as a possible danger.” Anand & Shipler (1994)

23. Questions to explore: • What are the possible issues in this case? • You are in charge of this clinic, and you hear the comments of your staff. How should you address this issue?

24. Case Vignette Chris is a 19 year old Caucasian youth who is seriously depressed. The depression is thought to be linked to the sudden death of his father and the increasing responsibility he is expected to shoulder for his mother and five sisters. Chris has attempted suicide. You are a provider who is self-identified gay. Chris and his mother come to you. They are both very quiet during the visit. Later you learn that Chris and his mother have requested a transfer to another therapist. Anand & Shipler (1994)

25. Questions to explore • What are the issues from Chris and his mother’s perspective? • What are the issues from the perspective of the provider who happens to be gay? • Brainstorm strategies to address this situation.

26. What does it mean to me? • You have been assigned the task of creating a definition of the following terms: • Culture, Inclusion, Diversity • Talk about the relationship/differences between your definitions and the definitions of others.

27. Summary • Discuss the importance of self-examination and the impact it has on one’s ability to deliver culturally competent services. • What are your goals for improving your cultural competence (i.e., What do I need to work on? What have I learned about myself?) • Am I ready to facilitate this module?

28. References Anand, R. & Shipler, L. K. (1994). Multicultural Case Studies: tools for Training. (2nd ed). National Multicultural Institute, Washington, D.C. Clements, P & Jones, J (2006). The diversity training handbook (2nd ed). London: Kogan Page. Cornish, J., Schreier, B., Nadkarni, L., Metzger, L. & Rodolfa, E. (2010). Handbook of multicultural counseling competencies. New Jersey: Wiley. Dr. Seuss. (1989). The Sneetches and other stories. New York: Random House. McIntosh, P. (1988). Working Paper 189. White privilege and male privilege: A personal account of coming to see correspondences through work in women’s studies. Wellesley College, MA.  Nile, L. N. (2008). Developing Diversity Training for the Workplace: A guide for trainers (9th ed).Washington, DC: NMCI Publishers.

29. Nile, L. N. (1997, May). The silent interview. Workshop conducted at the meeting of the National Multicultural Institute, Washington, D.C. Rowe, M. P. (2008). Micro-affirmations and micro-inequities. http://web.mit.edu/ombud/publications/micro-affirm-ineq.pdf. Sue, D.W., Capodilupo, C. M., Torino, G.C., Bucceri, J. M., Holder, A,M. B., Nadal, K. L., Esquilin, M. (2007). Racial microaggressions in everyday life:  Implications for clinical practice. American Psychologist, 62, 271-286. Washington, J. (2009). Advancing our communities: The role of social justice in multicultural psychology. New Orleans:National Multicultural Conference and Summit