Identifying Cultural Issues Including Bias in the Counseling Room (Video)

Valerie Proctor Greene, Licensed Psychotherapist and Life Coach at Thriveworks Chesapeake, leads an online workshop titled “Identifying Cultural Issues Including Bias in the Counseling Room.” Below, you’ll find information about Greene, followed by highlights from her presentation:

About Valerie Proctor Greene, Licensed Psychotherapist and Life Coach:

Greene is passionate about personal growth through self-reflection, mental health and wellness in marginalized populations, treating trauma, and advocacy for women and children. Here are some highlights from her career:

• 25+ years in clinical practice
• 9 years teaching Multicultural Clinical Practice at Simmons University MSW program
• Experience with PTSD, Domestic Violence, and Sexual Assault
• Consulted on numerous cases where trauma was overlooked and the symptoms/presenting problems were the sole focus of assessment and diagnosis
• Treatment began and therapeutic alliance was built. At this point, trauma came out or was missed altogether due to clinician’s perspective of the client’s narrative.

Workshop Goals

• Gain a clear understanding of the terms “Ethnicity,” “Race,” and “Culture,” both their definitions and distinctions
• Explore the role culture plays in our own lives; how it shapes our worldview and functioning
• Make the connection between culture and presenting problems in how counselors assess their clients
• Learn how to avoid premature diagnosis and assessment without exploring cultural context through the client’s narratives
• Expand on the trauma informed approach to treatment to better incorporate cultural systemic barriers

Definitions: Ethnicity, Race, Culture

1. Ethnicity: ancestry, specifically country of origin. Individuals usually possess several ethnicities, but may choose to identify with some more than others.
2. Race: a social construct based upon physical appearance and characteristics; becoming increasingly complex as more people are descendants of multiple ethnicities.
3. Culture: shared values, beliefs, worldview, and shared experiences such as language, religion, child rearing practices, gender roles, customs/rituals, shared history, and coping styles

Understanding Client Culture: Dig a Little Deeper

• The identifying information
• Family history, religion, values, gender roles, childrearing
• Community/environmental strength and challenges
• What, if any, vulnerable populations would the client belong to? (class, race, gender, sexual orientation, religion should be explored)
• This is their narrative—where we listen for trauma

Trauma and Cultural Context

• Here at Thriveworks, when we meet our client for the intake visit, our assessment includes asking if they have a trauma history. Many times the client will say no or they are not sure.
• After we develop a therapeutic alliance and gain trust, more of the narrative comes out in sessions
• How often can we say that we discover that there is a trauma history and the client comes from a background where it has been normalized? Too often this is due to cultural context or our own biases which are based upon what we may unconsciously normalize as well.
• Examples may be verbal or physical abuse, abandonment, community or war violence, extreme poverty, multiple losses to violence, or extreme bullying.

Misdiagnosing or Overlooking Trauma

• When we ignore cultural context we run the risk of prematurely pathologizing or misdiagnosing our clients
• Assessment and Diagnosis based solely on symptoms, negates environmental circumstances and/or systemic oppression which is likely a part of the sociocultural narrative and trauma of our clients
• The importance of naming trauma: When we hear trauma in our clients’ narratives, it is critical to name it as such. This validates that you see them as a person undeserving of the trauma. It negates victim blaming and acknowledges social injustices.

Approaches to Treatment: Trauma Informed Therapy and Social Justice Informed Therapy

In therapy, the Trauma Informed Approach includes and recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; responds by fully integrating knowledge about trauma into policies, procedures, and practices; and seeks to actively resist re-traumatization.

“While Trauma Informed Therapy is important, Social Justice Informed Therapy is even more important. One cannot fully practice Trauma Informed Therapy without understanding the trauma of social injustice.” –Maria Peredes, PhD

Keep the following in mind to use the Trauma and Social Justice Informed Approach:

• Remember what the term “culture” means
• Explore and become aware of your own culture and be open to facing your own biases
• Ask and listen for cultural context in the client’s narrative
• This should be done through the multilayered conceptualization
• As you hear trauma being normalized in the client’s history, name it as such
• Validate the experience as one that was not deserved and not the client’s fault
• Make sure they feel emotionally and physically safe
• Monitor and contain acute symptoms before any intensive exploratory work to avoid re-traumatizing
• When the client is not having acute symptoms and feels safe, begin the Trauma and Social Justice Informed Approach
• This includes validating the trauma as well as the systems of historical and present forms of oppression our clients often endure

Suggested Reading:

(Note: This suggested reading list looks at several different groups)

1. Nickel and Dimed: On Not Getting by in America by Barbara Ehrenreich
2. White Fragility by Robin Diangelo
3. The Deepest Well: Healing the Long-Term Effects of Childhood Adversity By Nadine Burke Harris
4. It Didn’t Start With You: How Inherited Family Trauma Shapes Who We Are and How to End the Cycle by Mark Wolynn
5. A Chance in the World by Steve Pemberton
6. Mona in the Promised Land by Gish Jen
7. The Velvet Rage: Overcoming the Pain of Growing Up Gay in a Straight Man’s World by Alan Downs
8. Caucasia by Danzy Senna
9. Other People’s Children: Cultural Conflict in the Classroom by Lisa Delpit

Suggested Viewing:

1. The Hate You Give
2. Just Mercy
3. Unorthodox

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