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Clinical Supervision: Models, Role, Legal & Ethical, Cultural Competency, & Transference
In the last section, we discussed "Five Cultural Adaptation Methods". These Five Cultural Adaptation Methods are Assimilation, Integration, Alternation, Rejection, and Marginalization.
In this section, we will discuss acculturative stress in culturally different clients the supervisee may treat, from an ethical perspective. At the end of the section, we will describe a case study and analyze the cultural factors at play in the situation.
Clearly when two different cultures come into contact, a complex cognitive process with emotional consequences is put into motion, resulting in stress. Traditionally the different levels of stress associated with acculturation have been referred to as the "culture shock" syndrome.
However, in recent years, the term acculturative stress has been used as a generic reference to the emotional difficulties experienced by culturally different clients who transition to a new environment and culture. "Culture shock" is now usually reserved for severe levels of acculturative stress that result in a client’s extreme lack of capacity to function in the new environment.
Obviously there are a number of consequences in daily living that result from coping with acculturative stress, even if the culturally different client is not dealing with the more severe "culture shock". Does your supervisee’s culturally different client complain of physical health problems? Or, maybe he or she has difficulties making decisions? As you are well aware, these can all be consequences of acculturative stress.
I have found, probably like you, that many models of acculturative stress pertain to specific groups, such as refugees, African Americans, and Hispanics. However, regardless of the specific cultural group, Williams and Berry point out that all models seem to encompass five factors that regulate the relationship between acculturation and stress.
5 Factors that Regulate the Relationship Between Acculturation and Stress
#1 - Mode of Acculturation
#2 - Phase of Acculturation
#3 - Nature of the Subculture
#4 - Characteristics of the Adapting Group
#5 - Characteristics of the Acculturating Individual
At the end of this section, I will describe the social isolation of Javier (hav’-yer) due to language spoken in the household and socioeconomic factors. Both of these contributed to regulate the relationship between acculturation and stress for Javier.
I have found that for culturally different clients dealing with acculturative stress due to any of the five factors - mode of acculturation, phase of acculturation, nature of the subculture, characteristics of the adapting group, and characteristics of the acculturating individual - often social support is the most comprehensive variable in moderating stress. By that I mean, culturally different clients that are members of groups with developed ethnic and cultural networks will likely suffer less stress.
Now let’s look at a short case study. As I explain Javier’s case, see if your supervisee can determine the factors contributing to his acculturative stress.
Javier, age 54 and Hispanic, began counseling sessions because he believed someone was planning to kill him and that something bad would happen to him. As these feelings grew stronger, Javier became more and more inhibited from doing things that required leaving his house. Finally, his paranoia became so strong that his wife, Dora (door’-ah) couldn’t even get him to go to work. Javier and Dora were born in Mexico and lived there until three years ago. They speak no English and are socially isolated from their neighborhood, a low-income, middle-age white neighborhood.
Although Javier was originally able to find work as a janitor, his job is at stake due to his paranoia. Dora knows that if Javier doesn’t keep the janitor job, he will likely not find another job because he cannot speak English. Dora herself cannot find a job because she stays home to take care of Rosa (rose-ah), their 13-year-old daughter and the last of their 10 children. Javier’s therapist, who was white, made little progress with Javier because Javier did not trust anyone who was not Hispanic.
Even with just the basic information given above, it is obvious that Javier is suffering from acculturative stress. What factors can your supervisee see contributing to Javier’s acculturative stress? Clearly, one factor is the nature of the subculture. The neighborhood in which Javier, Dora, and Rosa live is a primarily English-speaking neighborhood. For this reason, Javier’s neighbors tend to avoid him, which makes him feel he is in a prejudiced and discriminatory environment. This prejudiced and discriminatory environment in Javier’s subculture is also tied to the next contributing factor.
That contributing factor is the characteristics of the adapting group, or neighborhood. By that I mean, the neighborhood is low-income, middle-aged and white. Thus, these characteristics create no social support system for Javier, as he shares few of these characteristics. Finally, the last factor contributing to Javier’s acculturative stress are the characteristics of the acculturating individual, Javier himself. Javier refuses to learn English. This refusal to learn English continues to keep him isolated from his neighborhood and potential sources of support.
The therapist found encouraging Javier to vent his frustration during their sessions to be beneficial. This in combination with Rational Emotive Therapy (RET) became an effective tool in Javier’s enrollment in free language courses. RET was used to point out to Javier that it is irrational to expect to live a stress-free life when you refuse to learn to speak the language.
Does your supervisee have a culturally different client like Javier who seems to be experiencing acculturative stress? Would Rational Emotive Therapy be beneficial for his or her client? What ethical implications might this have on your supervisee?
In this section, we have discussed acculturative stress, as well as compared acculturative stress to "Culture Shock".
In the next section, we will discuss the modification of three common counseling microskills.
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