Read: Theory and Practice of Counseling and Psychotherapy, pages 43-45; and Addressing Diverse Populations in Intensive Outpatient Treatment I have attached additional reading material, I need this by Thursday,
Culture is important in substance abuse treatment because clients’
experiences of culture precede and influence their clinical experience.
Treatment setting, coping styles, social supports, stigma attached to
substance use disorders, even whether an individual seeks help–all are
influenced by a client’s culture. Culture needs to be understood as a
broad concept that refers to a shared set of beliefs, norms, and values
among any group of people, whether based on ethnicity or on a shared
affiliation and identity.
Retrieved from, Substance Abuse: Clinical Issues in Intensive Outpatient Treatment, Center for Substance Abuse Treatment (2006).
It is agreed widely in the health care field that an individual’s
culture is a critical factor to be considered in treatment. The Surgeon
General’s report, Mental Health: Culture, Race, and Ethnicity, states,
“Substantive data from consumer and family self-reports, ethnic match,
and ethnic-specific services outcome studies suggest that tailoring
services to the specific needs of these [ethnic] groups will improve
utilization and outcomes” (U.S. Department of Health and Human Services
2001, p. 36). The Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition (DSM-IV) (American Psychiatric Association 1994) calls
on clinicians to understand how their relationship with the client is
affected by cultural differences and sets up a framework for reviewing
the effects of culture on each client.
Because verbal communication and the therapeutic alliance are
distinguishing features of treatment for both substance use and mental
disorders, the issue of culture is significant for treatment in both
fields. The therapeutic alliance should be informed by the clinician’s
understanding of the client’s cultural identity, social supports,
self-esteem, and reluctance about treatment resulting from social
stigma. A common theme in culturally competent care is that the
treatment provider–not the person seeking treatment–is responsible for
ensuring that treatment is effective for diverse clients.
Meeting the needs of diverse clients involves two components: (1) understanding how to work with persons from different cultures and (2) understanding the specific culture of the person being served (Jezewski and Sotnik 2001). In this respect, being a culturally competent clinician differs little from being a responsible, caring clinician who looks past first impressions and stereotypes, treats clients with respect, expresses genuine interest in clients as individuals, keeps an open mind, asks questions of clients and other providers, and is willing to learn.
Members of racial and ethnic groups are not uniform. Each group is highly heterogeneous and includes a diverse mix of immigrants, refugees, and multigenerational Americans who have vastly different histories, languages, spiritual practices, demographic patterns, and cultures (U.S. Department of Health and Human Services 2001).
For example, the cultural traits attributed to Hispanics/Latinos are at best generalizations that could lead to stereotyping and alienation of an individual client. Hispanics/Latinos are not a homogeneous group. For example, distinct Hispanic/Latino cultural groups–Cuban Americans, Puerto Rican Americans, Mexican Americans, and Central and South Americans–do not think and act alike on every issue. How recently immigration occurred, the country of origin, current place of residence, upbringing, education, religion, and income level shape the experiences and outlook of every individual who can be described as Hispanic/Latino.
Many people also have overlapping identities, with ties to multiple cultural and social groups in addition to their racial or ethnic group. For example, a Chinese American also may be Catholic, an older adult, and a Californian. This individual may identify more closely with other Catholics than with other Chinese Americans. Treatment providers need to be careful not to make facile assumptions about clients’ culture and values based on race or ethnicity.
To avoid stereotyping, clinicians must remember that each client is an individual. Because culture is complex and not easily reduced to a simple description or formula, generalizing about a client’s culture is a paradoxical practice. An observation that is accurate and helpful when applied to a large group of people may be misleading and harmful if applied to an individual. It is hoped that the utility of offering broad descriptions of cultural groups outweighs the potential misunderstandings. When using the information in this chapter, counselors need to find a balance between understanding clients in the context of their culture and seeing clients as merely an extension of their culture. Culture is only a starting point for exploring an individual’s perceptions, values, and wishes. How strongly individuals share the dominant values of their culture varies and depends on numerous factors, including their education, socioeconomic status, and level of acculturation to U.S. society.
A first step in mediating among various cultures in treatment is to understand the Anglo-American culture of the United States. When compared with much of the rest of the world, this culture is materialistic and competitive and places great value on individual achievement and on being oriented to the future. For many people in U.S. society, life is fast paced, compartmentalized, and organized around some combination of family and work, with spirituality and community assuming less importance.
Some examples of this worldview that differ from that of other cultures include:
Common issues affecting the counselor-client relationship include the following: