Ethics in Psychotherapy and Counseling. Kenneth S. Pope

may block or diminish our cultural competence to work with specific groups or certain topics. Thus, it is vital to assess not only our intellectual competence but also what Pope and Brown (1996) termed emotional competence for therapy. We invite each of us to take a moment now to ask ourselves the following set of questions:

       Do you have positive or negative feelings toward most or virtually all members of any particular social groups based on their cultural traditions, values, and practices? Does a person’s skin color ever affect the way you view them or interact with them? How about a person’s religion (e.g., Muslim, Southern Baptist, Catholic, Mexicayotl, Hasidic Judaism)? Social class (e.g., those people known as the super-rich; those people who are poor and homeless)?

       If so, how if at all do you think it affects your clinical work?

       Would you feel comfortable hiring, supervising, or accepting as a client, or working with a member of that group?

       Would you feel comfortable sharing these feelings with your graduate school faculty, internship supervisors, employer, or colleagues?

       Have you shared these feelings with your graduate school faculty, internship supervisors, employer, or colleagues?

       Would you be okay sharing your thoughts publicly? Posting them on public social media accounts?

       How well do you believe your graduate program, internship, and continuing education courses have dealt with these issues? What improvements could you suggest?

       How well do you believe the profession has dealt with these issues? What improvements could you suggest?

       Do you believe the profession is paying too much, too little, or just about the right amount of attention to these topics?

       How do your own cultural values inform and shape the way you interact with clients?

       How do they impact your assessment and diagnosis of clients of cultures different from your own?

       How do your cultural values impact or inform your interventions?

       Do you ever consider how the client’s understanding, description, and expression of symptoms may impact treatment? If so, how do you integrate this information into your work?

      Becoming aware of the ways we may fail to recognize and respect a group that is different from our own challenges all of us. It is easy to recognize in theory, the influence of our own culture and context, but it often escapes our notice in practice. A remarkable book, The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures (Fadiman, 1997), illustrates the potential costs of overlooking the influence of culture and context on everyone involved. The book describes the efforts of a California hospital staff and a Laotian refugee family to help a Hmong child whose American doctors had diagnosed with epilepsy. Everyone involved had the best of intentions and worked hard to help the girl, but a lack of awareness of cultural differences had tragic effects. The book quotes medical anthropologist Arthur Kleinman:

      As powerful an influence as the culture of the Hmong patient and her family is on this case, the culture of biomedicine is equally powerful. If you can’t see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else’s culture? (p. 261).

      Looking Outward

Several models have been created to help us operate from a culturally responsive stance (see Adames & Chavez-Dueñas, 2017 CREAR-CE Model; Park-Taylor et al., 2009 Multicultural Competency Training Model). A well-established framework is White and Henderson’s (2008) multicultural competency building model which includes an actionable plan to develop and maintain cultural competency throughout our mental health careers and beyond. This model is divided into four levels including: (1) conceptual/theoretical/intellectual which underscores the importance of learning about our client’s culture at the deep structural level obtained by reading textbooks and journals, attending lectures and courses, and watching movies/documentaries; (2) engaging in challenging cross-cultural dialogues that provide the opportunity for emotional grow through active participation in difficult dialogues around individual differences; (3) behavioral engagement which emphasizes the importance of immersing ourselves in the context/community of the people we serve; and (4) building practical skills that enhance the therapeutic relationship which focuses on developing healing approaches that are tailored to the unique and complex needs of our clients (also see Adames et al., 2016; Henderson et al., 2014). According to White and Henderson, when we engage in activities at each of the four levels, we end up developing and deepening our cultural competency and improving the psychological services we provide.

      SCENARIOS FOR DISCUSSION

      You share a suite of offices with several other therapists. The name of each therapist is on the door to that therapist’s office. One morning you find that the door to one of the offices has been broken in and the office vandalized. The name on the door was Jewish. Swastikas along with epithets have been spray-painted on the walls, desk, floor, and bookshelves. You have no evidence but believe the vandal may have been one of your patients—someone who has expressed strong anti-Semitic views during therapy sessions, embraces the view that the Holocaust is fiction, and has described fantasies of vandalizing synagogues. But if you were to ask him during the next therapy session whether he had anything to do with vandalizing your colleague’s office, he would deny it.

       How do you feel?

       What would you like to do?

       What do you think you would actually do?

       Would you mention your suspicion that your client may have vandalized your colleague’s office to the colleague, the police, or anyone else? If so, how do you address issues of client privacy and confidentiality?

       Would you mention your suspicion to your client? If so, how?

       How, if at all, would you address your client’s anti-Semitism in therapy?

      ▪ ▪ ▪

You are a Latino psychotherapist who speaks Spanish only moderately well. Your policy is to try to refer all those who speak only Spanish to fluent Spanish speakers, but you will see Spanish speakers who also speak English if they wish. A South American client who speaks fluent English and Spanish sees you because you are the only Latino available on her HMO list. At the first session, she insists that you should be ashamed for not speaking better Spanish and that you therefore have no culture.

       How do you feel?

       What are your thoughts and feelings about this client?

       How would you respond to this client?

       Under what conditions would you continue to see or decline to see this client?

      ▪ ▪ ▪

      You have been leading a therapy group at a large mental health facility. As one of the sessions begins, a group member interrupts you and says, “I want to ask you about something. Have you noticed how none of the doctors here are People of Color but almost all the cleaning crew are? Why do you work in a system like that? Don’t you think that has any effects on us patients?”

       How do you feel?

       What are the possible replies you consider?

       What do you think you would say?

       What effects, if any, might such a system have on clients?

      ▪ ▪ ▪

      You work in a large office building. As your therapy client, a person of the Sikh faith, is getting ready to leave your office, the police show up at the door, handcuff him, and say they are taking him to the station for questioning. When they leave, the accountant across