After reading the interview with Dr. Derald?Wing Sue about Multicultural Competence in Counseling, please share 2-3 concepts from that interview that were new ins

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VICTOR YALOM: Hello, I'm Victor Yalom. I'm pleased to be here today with Dr. Derald Wing Sue. He's widely acknowledged as the leading authority in the field the multicultural counseling. He's the co-author, along with his brother David, of the influential and widely read textbook Counseling the Culturally Diverse, as well many other books– over 150 scholarly publications. Welcome, Dr. Sue.

DERALD WING

SUE:

Thank you.

VICTOR YALOM:I want to talk to you today about a wide variety of topics, but relating to your field of multicultural counseling. So, why don't we start more broadly. What does that mean, multicultural counseling?

DERALD WING

SUE:

Well, to me it means the ability to develop cultural competence in working with different racial, ethnic minority groups. And when I first started becoming interested in it, I noted that most of the theories of counseling and psychotherapy were white Western European in origin. Their primarily the creation of Western European men, which reflected a worldview that was quite different than the worldview I was raised in, with my parents. And it was out of that, that I began to really notice that counseling and psychotherapy traditionally was quite inappropriate and oppressive towards clients of color who came in for counseling and psychotherapy, because their worldviews were quite different from that that most traditional forms of therapy came from.

VICTOR YALOM:What alerted you to that? I'm sure many things, but I think many therapists would think that we work with lots of different kinds of clients, and everyone has a unique story, and part of our core of our basic training is to be curious, and empathic, and understanding, yet obviously in your eyes, that wasn't enough. So

DERALD WING

SUE:

No, it wasn't enough. And much of what I've come to understand about counseling and psychotherapy came through my own graduate training at the University of Oregon. I loved psychology. I went into counseling and psychotherapy, and loved the work of Leona Tyler, who was then really much into career, vocational, educational, and personal counseling. One thing that I discovered was that much of what they valued in terms of counseling healthy human development was not what I was raised to be. For example, I discovered that almost all of the professors I had emphasize individualism as the road to mental health. In fact, I was taught the developmental theories of Erikson, Jean Piaget– and almost all of them, I noted, equated healthy maturity and development was with individuation from the group.

Now, my father and mother always emphasized that I was part of the family. And that individuation, while it might be valuable in certain conditions, that becoming an individual often times meant that you would break away from the family and not have the collective identity that was so valued. As I went through graduate school, I also began to realize that what I read– Freudian psychology, existential, humanistic psychology– did not resonate with what I consider to be effective therapy with Asian Americans.

And then my first position was at the University of California-Berkeley where I began to do therapy with a number of Asian American clients, and with some of the African American clients– the students who came in. And the types of conflicts that they went through was not really addressed by traditional forms of counseling and psychotherapy, and in some sense pathologized their cultural values.

VICTOR YALOM:Such as?

DERALD WING

SUE:

For example, if an Asian American client came in and you were to give them an interest inventory, and it showed that they would be better off instead of in electrical engineering, to be in a field like forestry–

VICTOR YALOM:So in interest then to the story, this is in– you were doing career counseling?

DERALD WING

SUE:

Career coun– well, I did a number of things– career counseling, vocational counseling, and personal counseling. But this is representative of an issue that goes back. That in some sense, I would say that your strong vocational interest inventories indicate that perhaps you're on the wrong major, and maybe you should think about switching into something that you're finding more interest. And they would say to me things like well, before I can change my major, I have to check with my mother and father. And the way that I was taught was that here we have someone who is a junior in college, becoming– moving into adulthood. They should be able to make decisions on their own. And what I would be taught would be– traditional training– was that they were dependent, immature, and they should make this decision on their own. And I realized that if I impose those values upon them, I was pathologizing a cultural value in which it was considered very appropriate to first consult with your mother and father, or your parents, before going on and making a decision.

VICTOR YALOM:So that was kind of a microcosm of a real clash of worldviews.

DERALD WING

SUE:

Yes, and it was reinforced when my brother Stan was at UCLA doing research at the psychiatric institute there, in which he relaid stories to me about psychiatrists who would approach him and ask him, or make a comment, we know that you're doing research on Japanese American clients, did you know the Japanese are the most repressed of the clients we've ever work with? And it was then that Stan and I formed the Asian American Psychological Association because we knew that among Asians, traditional Asians especially, restraint of strong feelings was considered wisdom and maturity, and free expression of feelings were indeed considered immature. And that's why one's ability to control their feelings and emotions, among Asians, oftentimes led to the concept of the inscrutable Asian, which again was an indication of pathologizing a strong cultural value, because counseling and psychotherapy wants our clients to freely express their feelings. And this is considered a cultural taboo among many Asians and Asian Americans who come in for help.

VICTOR YALOM:Yeah, so it sounds like you were quickly confronted with the cultural biases of what is normality, what is a positive mental health, what is psychopathology, and how embedded that was in culture.

DERALD WING

SUE:

True, and with that under our belt– Stan and I had formed, like I was saying, the Asian American Psychological Association– he began to do a number of major studies in the utilization of mental health services by individuals of color in the entire state of Washington. And three of those groundbreaking studies indicated several important things that really jarred my concepts about mental health, and began to introduce what I consider to be a social/political element in counseling. And that was that people of color tended to underutilized nearly all of these psychiatric services in the state of Washington in proportion to their population. The second outstanding finding was that once people of color did go in for counseling and psychotherapy they terminated at a rate of over 50% after the first initial contact. This is in marked contrast really to a less than 30% premature termination rate among white clients who came in.

Now this led me to begin to ask the question, why is it so? Why is it that regardless of the group– and now I'm talking not only about Asian Americans, the study encompassed Latino Hispanic Americans, African Americans, and Native Americans, and white Americans– and regardless of the four racial/ethnic groups, they all prematurely terminated and underutilized. So the question we had was why. One of the things we talk jokingly entertained was the fact that, well, people of color are mentally healthier and don't need that type of treatment, and are cured quicker after only one session. We don't really believe that. We believe that in terms of all the studies that mental disorders and personal problems are probably pretty equal across all racial/ethnic groups, although they're manifested quite differently.

But when we asked that question, we began to arrive at the answer that it was the inappropriateness of the transactions that occurred between the mental health professional and the culturally diverse clients who came in for counseling.

Now this lead us to begin to talk about– what is there about counseling and psychotherapy that may prove antagonistic to the cultural values of all four of these groups of color. And we began to look at what we call culture-bound values. For example, cultural-bound values were things like individualism, in which psychology believes that the psychosocial unit of operation is the individual, while 3/4s of the world, the psychosocial unit of operation is the family, the group, or the collective society. And that creates problems.

The other thing that we noted was that most forms of counseling and psychotherapy, even if it is cognitive behavioral in origin, values a certain amount of insight. That is that you're considered mentally healthier if you have insight into your own personal conflicts, motivations, and behaviors. And again we realized that, for example, my father always would, if I was anxious, his advice to me would always be Derald, don't think about it. Now, I was saying is he a quack? That goes against what I was taught as a psychologist. You think about it, you explore it, you get insight, you introspect.

Later what I learned in terms of studies done at Berkeley was that to traditional Chinese, the road to mental health was the avoidance of morbid thinking. And in fact, my father would oftentimes say to me that you're thinking– the reason why you're anxious is that you're thinking too much about it. And we all know the work of Richard Lazarus at Berkeley on stress coping, and it was in, I think, the 1980s where it became very well known for healthy denial as a road to mental health, which was directly against the psycho-dynamic concepts of insight. And I tell people that I've always resented Lazarus' work because he received all the credit, and my father should have been the one that got the credit for that.

These are culture-bound values, but there were class-bound values. counseling and psychotherapy has traditionally been directed at middle, upper-class individuals. The assumption being that you have time to sit, and introspect, and talk about this. People coming from poverty don't enjoy– they come in, and what they want is, how can I feed my family? Where can I get my next job? How do I get medical help? These are immediate issues that clash with the 50 minute hour, once a week, type of work.

And the third area we looked at was that linguistic factors oftentimes worked against culturally diverse clients who would come in, because the primary mode of counseling and psychotherapy is verbal behavior. Standard English. And what we found was that the large gap between translation oftentimes– even if the Latino client can speak English– the translation was totally different in terms of affect, and types of expression, and even interpretation.

VICTOR YALOM:What do you mean that the interpretation was different? Are these for native speakers, or non-native speakers?

DERALD WING

SUE:

Well, see, this is really interesting. People assume that if you have been born and raised in the United States, and you're Latino, that you should be able to master English. Studies suggest that the acquisition of English is even different if you have parents that speak the language of Spanish, or Chinese. It affects how you put together English. And what we're finding is that if a person feels shy, feels anxiety, there are different translations of that. And when the client can't voice it in English, what we find is that if you allow them to voice it in Spanish, they tend to do better than if they're locked into a primary linguistic interpretation.

But it's these three things that really began to make me realize that rather than heal and liberate, counseling and psychotherapy can be very oppressive and make the person feel worse. And those were the findings. That many of the individuals who prematurely terminated would come out and make statements like that, you know, we felt worse. We felt we were to blame.

VICTOR YALOM:So you went and interviewed the people who just came in once?

DERALD WING

SUE:

Not that population, but other populations that came out. We began to talk to individuals that had gone through counseling and therapy, and they came out saying certain things. One of the things is that, I just don't feel comfortable with Dr. Smith. He doesn't seem to be able, or she doesn't seem to be able, to relate understand what's going on with us. Or they may mean, I'm not sure I can trust Dr. Smith because of certain things that are going on.

VICTOR YALOM:So this is typically minority clients, white therapists?

DERALD WING

SUE:

Yes, yes.

VICTOR YALOM:All right.

DERALD WING

SUE:

But the other thing that came out in our findings were statements that therapists tended to be color-blind. That is that they found it very difficult to talk about racial/ethnic cultural issues. Many clients would say that they could feel uncomfortable anxiety from the therapist when issues of race arose. And they would feel like, I'm not sure– if the therapist is uncomfortable with talking about race, I'm not comfortable going to the therapist for help in any respect. Now, this led us to– and stop me any time you want, this led us to–

VICTOR YALOM:Well, let me ask you. So, did you have a sense, or did you get info on what gave them the sense that the therapist wasn't comfortable? Was it just body language, tone of voice, avoidance?

DERALD WING

SUE:

Yes, OK. One of them was color-blindness. That is that the therapist would emphasize things like– when a racial issue would come up– the therapist would say something that, if I'm going for therapy, Derald, I don't see you as Asian American at all. You're unique, you're just unique. Or that you're very much like me, we're human beings. There's only one race, the human race. I would feel offended, like many clients of color, that an important aspect of my racial cultural identity was being overlooked and ignored, and seen as something that we should not talk about.

VICTOR YALOM:And I'm just wondering, I imagine if you asked the therapist they might think they're trying to connect with the person and point out that they don't see that person is differently, but it's not having the intended effect.

DERALD WING

SUE:

You know, and that is one of the issues I have with the conference here. The Evolution of Psychotherapy conference.

VICTOR YALOM:Can we cut that– I just want this to be kind of a free-standing interview that's not tied to that, so let me restate what I just said, and we can go on from there, if that's all right.

DERALD WING

SUE:

All right.

VICTOR YALOM:But you can talk about the field in general. So, I'm just wondering if you asked the therapist why they might make an intervention like that, or a statement like that, they might think that they're trying to connect with the client and showed that they don't feel different, that they understand the client, but it sounds like it might have a very different effect on the client.

DERALD WING

SUE:

That's precisely– one of the things that oftentimes happens in counseling and psychotherapy is that the therapist, in their attempt to look unbiased, that they won't discriminate, they tend to downplay the group identities that people have by moving to the individual identity or the universal one. And I know in terms of intentionally, the intention is that I want to connect with similarities, or issues that aren't related to possible biases. The problem with that is that it communicates an invalidation of a client's racial, cultural, ethnic identity. The second thing is that it communicates that the person is reluctant or anxious to touch the racial issue that might be important to deal with therapeutically. And the third thing, that oftentimes is communicated with what I call a color-blind approach, or the emphasis on sameness or individuality here, is that differences are deviant. Whether the therapist is aware of it or not, the emphasis on sameness is almost an escape, or a belief that being the same is good, but being different is divisive and causes differences.

In multicultural counseling and therapy, what we try to do is to teach individuals that we have all three levels of identity. We have a universal level of identity that is like what Shakespeare's character Shylock says that, when I cut myself, do not I bleed? That statement that we do share universal identity. There is the individual level of identity that Milton Erickson talks about, which is that we are all unique, we are all different in some way. There is a third level of identity– VICTOR YALOM: Do you mean Milton or Erik? DERALD WING SUE: Erik. VICTOR YALOM: OK, let's can we do–

DERALD WING

SUE:

No, Milton.

VICTOR YALOM:Oh, you did mean Milton.

DERALD WING

SUE:

Yes, I did mean– I mean, if you look at the statement.

VICTOR YALOM:OK, I just thought– you might think, you were at the conference, I just didn't want you–

DERALD WING

SUE:

Erik Erikson is a developmental–

VICTOR YALOM:Yeah I know, I know.

DERALD WING

SUE:

He would share that as well, by the way. VICTOR YALOM: OK, I just– I didn't want to–

DERALD WING

SUE:

Am I touching too much on political issues?

VICTOR YALOM:No, no, that's fine. But it would be helpful if you pause a little so we have a chance to interact more, I know you're used to lecturing. So you were going on the three levels, so why don't you go back to the three levels.

DERALD WING

SUE:

The second level that I was talking about is one of individuality, that we are all different in one way or another from individuals. The third level that I find therapists– and many individuals, not just therapists– find very difficult to touch is a group level of identity, which includes race, gender, sexual orientation. Any time those identities or issues are brought up, therapists and other individuals tend to move to the individual level of identity or the universal level of identity. And there you have a missed connection. And this is what many of the clients that I've talked about, racial/ethnic minority clients that I talk to, say that they don't feel the individual, the therapist, is able and ready to connect with them. The just feel kind of this barrier that is between them.

VICTOR YALOM:The therapist is not able to acknowledge the group aspect of it, and I would imagine again it's something that therapists don't want to be perceived as racist, or–

DERALD WING

SUE:

Or that they are. See, that's a powerful statement. In our work, and this is research that we've done with groups of color with white individuals. In fact, what we find is that there are four different levels of unravelling about why therapists may find it difficult to directly address or talk honestly about racial issues in counseling and therapy.

The first level that we're dealing with on a very superficial, is the fear by the therapist that whatever they say or do will appear racist, even if they aren't. The fear is there. Now, that constricts their ability to verbally interact with the client, because they either to dilute the conversation, move to a different level, or show constriction. Some therapists who have done research on it call it rhetorical incoherence. That is a therapist is incoherent when it comes to talking about these racial/ethnic issues.

The second level is the most feared level. And that is the level of realizing that you do have these biases and prejudices, although they are outside the level of your conscious awareness. And it is difficult for therapists to realize that because it conflicts with their image as good, moral, decent human beings.

VICTOR YALOM:That's probably difficult for anyone to realize that, yes?

DERALD WING

SUE:

Yes, in fact this is something why much of my research doesn't deal primarily with therapists anymore, it deals with teachers, it deals with employers, coworkers. It is representative of what I think therapists however are going through. But that shatters their image of themselves as being good, moral, decent individuals. And they are. It's just that they're out of contact with the implicit biases that come out unsuspectingly, and in inconvenient times, that the person of color, the client of color, picks up very easily.

VICTOR YALOM:Is this what you refer to as microaggressions?

DERALD WING

SUE:

Part of it, yes. Microaggressions. And microaggressions– I'm changing the topic.

VICTOR YALOM:OK, we'll get back.

DERALD WING

SUE:

Microaggressions are the everyday indignities, insults, invalidations, and put-downs that well-intentioned individuals deliver to marginalized groups– like people of color, women, LGBTQ individuals– unknowingly. It is outside the level of their conscious awareness. The microaggressions on the surface appear to be innocent inquiries, complements. But indeed they contain a meta-communication, a hidden message, that invalidates, insults an individual. And these microaggressions, that can be delivered by anyone, especially damaging in therapy, by the therapist, can be verbal, nonverbal, or even environmental. How their offices is set up is oftentimes invalidating.

VICTOR YALOM:How could that be?

DERALD WING

SUE:

Well, let me give you an example. If you're a therapist, and you have pictures of all of the major founders of therapy– Sigmund Freud, B. F. Skinner, Carl Rogers. If you have those on your wall, a person who comes in, a client of color who comes in, will see those pictures and associate them as primarily white Western European. Will this person understand who I am in terms of the race and culture that I come from? Or if you have a female client and they see pictures of just all male therapists on the wall, they're going to begin to think about, is there sexism that is operative in here?

Now they may not even be able to verbalize it. They would just feel uncomfortable, that perhaps there's a disconnect that is going on here. But that's an environmental– how you decorate your office oftentimes communicates either receptivity or invitation according to cultural themes, as opposed to other groups that might read it. This is where the therapist is unintentionally delivering microaggressions, and each time those microaggressions are delivered the credibility of the therapist diminishes.

VICTOR YALOM:Now, I'm wondering why you use the term microaggressions. I mean, I could imagine a therapist thinking these are the people they studied– or I don't know a lot of therapists do have pictures of all these on their wall– but, to go with your example, I can certainly understand that it may not make a client of color feel comfortable, and that's something certainly to consider. But why do you call it a microaggression?

DERALD WING

SUE:

Well, microaggressions is a term coined by Chester Pierce, and African American psychiatrist who did studies of TV programs, advertisements, that portray people of color and women in what he considered to be demeaning issues, or the portrayals that were going on. And his studies indicated that these portrayals had negative impact on the self-esteem and integrity of people who were receptive to it. Now, advertisers didn't know. They thought they were doing something quite well.

It is also a term used by Maya Angelo. She refers to microaggressions as the daily insults, the many cuts that are delivered to individuals. Any one alone may not be that drastic, but taken cumulatively they have major harm. And she oftentimes equates this to the little executions versus the grand execution of an overt racist that is going on. And the term is micro, but the impact is macro. Macro in terms of the– it has major pain that people experience.

VICTOR YALOM:All right, well I know you've written a whole book on that, and that's been in a big area of your work. And we could spend a lot of time on that. But let's get back to the therapist. You had listed points one and two, and so let's continue with that.

DERALD WING

SUE:

A third point that makes, I think, therapists really quite anxious about talking about racial, gender, or sexual orientation issues is social/political. Which many of my colleagues really don't want. What I'm talking about this power and privilege. We're dealing with the fact that many well intentioned therapists do not realize that people of color, in relationship to white individuals in this society, come from a disadvantaged position– because of a concept that is gaining wide usage, white privilege.

White privilege are the unearned benefits and advantages that accrue to groups on the basis of their white skin. And so, when the therapist responds to an individual that– let's say a black client– that, I think if you work hard enough, that you can achieve this goal. Because everyone has an equal opportunity in this society. It is a microaggressions and that is called the myth of meritocracy.

And I'd like to give the example of what this means that deals with the racial realities of white therapists and clients of color. The example that I like to give that embeds this issue of white privilege and power is a statement that columnist Molly Ivins in the Austin Times, she passed away years ago, wrote about George Bush. And she wrote and made this statement– George Bush was born on third base and believes he hit a triple.

This is where many CEOs, many people who achieved in society who are white, tend to have the feeling that they worked hard, sacrificed, and achieved what they did. And in reality, they did. They worked hard. But what they don't realize is that women and many people of color have worked equally hard, but don't even make it to the batter's box. That George Bush profited from male privilege, economic privilege, and white privilege. They're unearned advantages, and that's the way our society operates.

And clients of color, when they come in talking about these issues, generally feel put-off if the therapist cannot understand what a privilege and power is all about. And that many of the statements or assumptions that they operate from, operate from privilege and power that disempowers clients of color. And this is what happens in terms of the relationship that occurs.

VICTOR YALOM:All right, and then the fourth?

DERALD WING

SUE:

The fourth one is that, if you are a therapist, and you realize that you have power and privilege. You realize that you are biased, that this is made clearly, that you understand. It goes to another saying that someone once said, in that the ultimate white privilege is the ability to acknowledge your privilege and do nothing about it.

And I'm not inditing all therapists, but I'm saying that as a person of color, I've got to do something about it. I face this every day. But that many of my well-intentioned white brothers and sisters simply will acknowledge that they have advantages, that racism exists, but they don't do anything about it. And I realize why it is that they don't do anything about it, because for them, to do something about it means that they will alter their relationships with other individuals.

When they have family members telling racist, sexist jokes– it disturbs them, but for them to try to bring it up and correct it, will isolate them from the family. It means a really major change in your life, and that's very difficult for many well-intentioned individuals to do.

VICTOR YALOM:All right, so you've certainly laid a strong case for the fact that traditional mental health treatment wasn't working when you first started for minorities. And that many therapists, white therapists, are uncomfortable in terms of dealing with race for a number of different reasons and on different levels. So, you've been obviously involved in training therapists, and advocating multicultural competence, as you call it, for therapists. So, what does that mean and how do you inculcate that in students and therapists?

DERALD WING

SUE:

When I do want multicultural training, there are four major goals that I believe leads to cultural competence.

VICTOR YALOM:OK, first of all, what does that mean, cultural competence?

DERALD WING

SUE:

Cultural competence is the awareness, knowledge, and skills that allow you to work individually and systematically in an effective way that is culturally congruent with the populations that you're serving.

VICTOR YALOM:Sure, that's something I think we would all strive to.

DERALD WING

SUE:

Yes, but how it's interpreted is quite different.

VICTOR YALOM:OK.

DERALD WING

SUE:

It's like saying that we all stand for equal access and opportunities.

VICTOR YALOM:Sure.

DERALD WING

SUE:

Everyone would agree to that.

VICTOR YALOM:Absolutely.

DERALD WING

SUE:

However, if I say that a part of equal access and opportunities is affirmative action– oh, a lot of people who agree to the first– when you operationalize it in specificity, you get objections of that going on.

VICTOR YALOM:Sure.

DERALD WING

SUE:

But, that to me is a broad definition of cultural competence which if you operationalize it, has four components. The first component is awareness of your own worldview– the values, biases, prejudices, and assumptions that you hold. And the worldview of the theories that you are working from. Because those are the theories, and your worldview, that is allowing you to determine normality, abnormality, healthy, unhealthy functioning. I find that very

Difficult. And part of the understanding of worldview is not just your cultural understanding. It goes back to what I said before– what does it mean for you as a white therapist to be white. And I find people find it very difficult. If you ask me, what does it mean to be Asian American? I think I could tell you very quickly. If I asked a black American–

VICTOR YALOM:Well, let me ask you, what does it mean to you?

DERALD WING

SUE:

It means collectivism, family values that are very close to one another, it means a group consensus that occurs. But I think the point I'm trying to make here is that as a person of color, I wake up in the morning, and I look in the mirror, and I know I'm Asian American. If I ask you, when you wake up in the morning, and look in the mirror, do you say, jeez, I'm white.

VICTOR YALOM:No, I don't.

DERALD WING

SUE:

Yep. That's because whiteness is the def

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