Cultural humility and broaching difference

1. Difficult Dialogues:
Broaching Cultural
Issues in
Counseling
Dr. Sheila Addison
Interim Program Director, MACC
Alliant International University, SF
saddison@alliant.edu

2. Learning Objectives
Attendees will be able to:
1.Describe the difference between cultural
competence and cultural humility as
approaches to counseling work
2.Articulate professional and clinical rationales
for broaching cultural issues during counseling
3.Generate examples of how to broach cultural
issues during counseling sessions

3. MA in Clinical Counseling
Alliant International University, SF (est. 2010)
 Strengths-based perspective
 Multicultural, social justice
focus
 ACA social justice advocacy
competencies
 Cultural humility model
 Emphasis on critical
consciousness & inquiry
 Self-reflection & personal growth
 Providing training to under-
represented students
 Providing service to under-served
populations

4. MA in Clinical Counseling
Alliant International University, SF (est. 2010)
 ACA Social Justice Advocacy Competencies:
 Client empowerment
 Client advocacy
 Community collaboration
 Systems advocacy
 Public information
 Social & political advocacy

5. Cultural humility model
 Developed for physician training (Tervalon &
Murray-Garcia, 1998)
 Expanded to social work (Ortega & Coulborn
Faller, 2011; Schuldberg et al., 2012) and
counseling psychology (Hook et al., 2013)
 “Comptetency” emphasizes “knowledge”
 Humility: “having a sense that one’s own
knowledge is limited as to what truly is another’s
culture.”
 “Embrace the failure” (Wilchins, 2004)

6. Cultural humility model
 The “ability to maintain an interpersonal
stance that is other-oriented rather than self-
focused, characterized by respect for others
and a lack of superiority”(Hook et al. 2013)
• Critical for developing “a
strong bond in a situation in
which relationship partners
may have a strong tendency
to value their own
perspective.”

7. Cultural humility model
 Lifelong commitment to
self-evaluation & critique
 Make hypotheses rather
than jump to conclusions
 Overcome the tendency
to view one’s own beliefs,
values, and worldview as
superior
 Accept you will always
be naïve about others’
cultures

8. Cultural humility model
 An “antidote to or brake on feelings of superiority,
frustration, and alienation” that may occur when
cultural differences arise in therapy
 An ability to stay open and other-oriented when
clients are touching on aspects of identity that are
most salient to them

10. Cultural humility model
 Manifests in an ability to express respect and
take a one-down stance, even when
difference threatens the therapeutic alliance

11. Cultural humility model

12. Cultural humility model

13. Broaching cultural issues
Day-Vines et al., 2007
 Directly addressing
issues of culture and
identity that
translate into
dynamics of
privilege and
oppression that
influence the
presenting issues, the
client’s history, and
the counseling
relationship.
“The counselor’s
consideration of racial and
cultural factors that may
influence the client’s
counseling concerns.”

14. Broaching cultural issues
Day-Vines et al., 2007

15. 15
 Rationale
 Demographic shifts in population
 Homogeneity of counseling force
 Negative perceptions from minorities
 Ethical responsibility
 Counseling competencies
Broaching cultural issues
Day-Vines et al., 2007

16.  Current context:
 White supremacist
 Anti-immigrant
 Anti-Muslim
 Misogynist
 Heterosexist, ableist, sizeist, ageist, classist, etc.
 Scott & House (2005) – High levels of discrimination
distress associated with avoidant coping styles, whereas
feelings of mastery and control correlated with coping
strategies such as seeking social support and problem
solving in a sample of high school students.
 Powell & Jacob Arriola (2003) – examined the
relationship between psychosocial functioning and GPA
in students of color. Talking about unfair treatment was
associated with higher GPAs.
Broaching cultural issues
Day-Vines et al., 2007

17.  Previous research indicates that cultural
misunderstanding contributes to premature
termination among clients from culturally and
linguistically diverse backgrounds.
 30% of clients prematurely terminate. But 50%
of minority clients prematurely terminate.
 What could explain this?
Broaching cultural issues
Day-Vines et al., 2007

18. Damage of micro-aggressions
Damage of silence about cultural
factors
 Minority clients leave therapy early
and fail to get as much benefit.
 “A counselor’s refusal to both develop and exercise
multicultural counseling competence represents a
potential act of malfeasance toward clients.” (D. Sue
& Sundberg, 1996).
Broaching cultural issues
Day-Vines et al., 2007

19. Damage of micro-aggressions
 Brief and commonplace daily verbal,
behavioral, or environmental indignities,
whether intentional or unintentional, that
communicate hostile, derogatory, or
negative slights and insults toward
people of marginalized identities
Microaggressions

20. Microaggressions

21. Microaggressions

22.  Recipients: distrust, confusion, frustration,
anger, depression, RAGE
http://www.microaggressions.com/
Microaggressions

23. Damage of silence about cultural factors
Across the developmental spectrum, people from
culturally and linguistically diverse backgrounds
experience racialized stressors
Van Ausdale & Feagin (2001): ethnographic study
to determine whether preschool students
confronted issues of race and representation.
Spoiler: THEY DO.
Broaching cultural issues
Day-Vines et al., 2007

24. Broaching cultural issues
Day-Vines et al., 2007

25. 25
 Lewis (2005)
 Ethnographic study of children in a suburban
elementary school to examine parents’ and
teachers’ concept of race, their own racial
identities, and the impact of race on
opportunity structures.
 Even though respondents vehemently denied
the role of race within the school and
community, race operated as part of the
hidden curriculum. Essentially, race was very
salient.
Broaching cultural issues
Day-Vines et al., 2007

26.  White counselors who addressed racial and cultural
factors were deemed more credible than those who
ignored racial and cultural factors (Zhang & Burkard,
2008).
Broaching cultural issues
Day-Vines et al., 2007
 When clients of color for whom
race, ethnicity, and culture
were salient identity dimensions
perceived that counselors
lacked the capacity to broach
racial, ethnic, and cultural
concerns, clients opted to meet
their needs outside the
counseling relationship within
the safety and familiarity of
friends and family members
(Pope-Davis et al., 2002).

27.  Power dynamics within the counseling dyad
can promote or inhibit culture-specific
discussions, leaving clients feeling frustrated
and unheard (Thompson & Jenal, 1994).
 Higher levels of race neutral attitudes were
associated with lower levels of multicultural
counseling (Burkhard & Knox, 2004; Neville, Spanierman, &
Doan, 2006)
 Race neutral attitudes among White counselors
was associated with endorsement of racial and
gender intolerance, racist attitudes, victim
blame perspectives, acceptance of social
dominance, and apprehension around ethnic
minorities (Spanierman, & Heppner, 2004; Neville, Lilly, Duran,
Lee, & Brown, 2000)
Broaching cultural issues
Day-Vines et al., 2007

28. 28
Failure to broach:
Loss of counselor credibility
Client dissatisfaction
Client censure of own thoughts
Client accommodates the counselor’s inability to
broach racial and cultural factors
Client educates counselor in ways that detract
from the counseling process
Premature termination
Broaching cultural issues
Day-Vines et al., 2007

29.  Given the power dynamics that
govern the counseling relationship,
avoidance of the client’s cultural
context may prevent the client from
addressing pertinent counseling
concerns.
 Acknowledgement of cultural factors
during the counseling process
enhances counselor credibility, client
satisfaction, the depth of client
disclosure, and clients’ willingness to
return for follow-up sessions (D. Sue &
Sundberg, 1996).
Broaching cultural issues
Day-Vines et al., 2007

30.  “There’s a wilderness of creative space
in the therapeutic dialogue for the
recognition of race and class, how they
inform who we are, decisions we make
or decisions we fail to make. Because
there’s no aspect of our lives that aren’t,
I believe, shaped by the nuances of all
these issues—race, class, gender, all of
those things.”
Broaching cultural issues
Day-Vines et al., 2007
Dr. Kenneth V. Hardy, Drexel University, Ackerman Institute
for the Family

31.  “It’s really important to me to name
race very early in the process…. I’ve
written about the importance of the
therapist being the broker of permission.
And I think that that permission to
acknowledge and talk about race has
to be given before it ever happens
because the rules of race in our society
is that we don’t talk about it. So I use
myself to do that. “Well, as an African-
American” or “as a black therapist,”
which is my way of saying to you, the
white client, “I’m okay acknowledging
race. I’m even okay if we talk about it.”
Broaching cultural issues
Day-Vines et al., 2007

32.  “I believe that permission granting maneuver requires
some subtlety. I don’t agree with the strategy
where white therapists ask clients of color, ‘How
do you feel about being in therapy with me?’ I
also don’t agree with me asking a white client that
because of power. In that context of therapy, I’m in a
more powerful role. And so I would be asking this
person to engage in a level of self-disclosure about a
very difficult topic while I’m not revealing anything
about myself. It’s my job, the way I see it, to put my
views out there about it and not require an answer.
It’s up to the client if they want to pick it up and go
with it. But my putting it out there is not
contingent on them picking it up and going with
it. So it’s not like a chess game.”
Broaching cultural issues
Day-Vines et al., 2007

33. 33
Broaching behavior
involves selective
attention to cultural
factors that may
impact the client’s
sociopolitical
experience.
Broaching cultural issues
Day-Vines et al., 2007

34. Broaching cultural issues
Day-Vines et al., 2007
We have an
obligation to make
sure we don’t screen
out clues about the
salience of cultural
factors because it is
most comfortable for
us to do so.

35. Broaching cultural issues
Day-Vines et al., 2007
“I think that these fears are impediments to
talking and yet I think there’s a greater
likelihood to be a problem when it doesn’t
come up than when it does come up. And
I’m not just talking about bringing up race
with clients of color. I’m not just talking about
discussing gender with women. I mean, I
think it’s important for us to have these
conversations with clients across the board
and have an openness to look at them. See,
I guess that’s the difference. I’m keenly
interested in knowing how one’s life and
relationships are informed by all of these
issues, no matter who’s sitting in front of me.
Because I think they do inform our lives
though we may not always be conscious of
it.”

36.  Racial, ethnic, and cultural
factors may not impact every
presenting concern, but the
counselor has an obligation to
consider the extent to which
culture does serve as a context
for the client’s concerns. That is,
the counselor’s broaching
behavior serves as an
assessment tool.
Broaching cultural issues
Day-Vines et al., 2007

37. Broaching cultural issues
Day-Vines et al., 2007

38. Broaching cultural issues
Day-Vines et al., 2007
 Only broach when there
is visible difference? No!
 Broach similarity rather
than pretending that
you’re identical - that’s
an oppressive force
saying to the client that
they don’t have
permission to be
different from you.

39. Broaching cultural issues
Day-Vines et al., 2007
 Depends on
 “The counselor’s ability to consider how socio-
political factors such as race influence the client’s
counseling concerns.” – our clinical imagination
and empathy!
 The therapist’s willingness to directly address these
dynamics, knowing they will then become visible
in the therapy room
 Willingness to consider how the counseling
relationship might suffer if these factors are NOT
addressed overtly.
 Broaching combats silence.

40. Possible Feelings of:
•Resentment
•Embarrassment
•Fear
•Excitement
•Enthusiasm
•Curiosity
•True Rapport
•Incompetence
Address
Countertransference
Issues
Normalize
Student
Feelings
Brainstorm adjectives that describe your
personal feelings and level of efficacy towards
broaching behavior

41. 41
Continuum of Broaching Behavior
Avoidance of
Broaching
“Way of Being”
Lowest Level Highest Level
Invitation/Dialogue
Isolated
Integrated/C
ongruent
Broaching
Behavior/Attitude
Moderate to Advanced
Continuing/Incongruent

42. Avoidant Counselor
 “The client's race does not matter because
good counseling is good counseling.”
 “Broaching racial and cultural factors represents
the client's effort to avoid taking responsibility for
her or his actions.”
 “If my client were to bring up racial and cultural
factors, I would politely redirect the
conversation.”
 “I am not sure that broaching is an effective
counseling strategy.”

43. Isolating Counselor
 “I’m worried that the client won’t benefit from
it.”
 “I can try it, but if I don’t do it well, I’m afraid
I’ll lose the client and it’s not worth the risk.”
 “It just seems like projecting an agenda onto
the client before they’re ready.”
 “Whew, checked off that box…”
 Resulting Behavior: Broaches reluctantly and
in a simplistic and superficial manner.

44. 44
Continuing/Incongruent Counselor
 “I feel really awkward when I address racial and
cultural factors during the counseling process.”
 “Sometimes it’s hard for me to know what to
say once the client begins to talk about racial
and cultural factors.”
 “I asked if the client was OK having me as a
therapist and they said it was fine.”

45. Integrated/Congruent
Counselor
 “I generally bring up cultural issues every so often
throughout my counseling sessions with clients”
 “I want to know what my minority clients have
experienced in terms of racism and
discrimination.”
 “I try to make it safe for clients to talk about
cultural factors in their lives.”
 “I ask about difference, because difference
matters.”

46. Infusing Counselor
 “As a counselor, I want to do whatever it takes,
socially and politically, to eradicate of all forms of
oppression.”
 “Disagreeing with discrimination isn’t enough. We
have to change the system, even if it’s at our own
expense sometimes.”
 “I’m willing to go to bat for a client who
experienced racism or sexism at my agency.”

47. Effects of broaching
 Establishing rapport
 Establishing counselor credibility
 Acknowledging that difference may be
an influence on the relationship
 Giving permission to the client to
comment on their experience of
difference in the room
 Giving permission to the client to discuss
the effects of outside cultural forces

48. Multidimensional Model of
Broaching Behavior (Day-Vines, 2007)
4 Dimensions
 Intra-Counseling
 Intra-Individual
 Intra-Racial, -Ethnic, -Cultural, etc.
 Inter-Racial, -Ethnic, -Cultural, etc.
Spotlighting the Elephant in the
Room

49.  The interpersonal processes that govern the counselor-
client relationship.
 Cultural differences and misunderstandings between the
counselor and client have the potential to create an
unhealthy power dynamic within the counseling dyad, which
may contribute to counter-transference.
 Broaching Example: "I know that this can sometimes be a
difficult topic to discuss, but I was wondering how you feel about
working with someone who is from a different racial/ethnic
background? I ask because although it is certainly my goal to
be as helpful to you as I possibly can, I also know that there may
be times when I cannot fully appreciate your experiences. I
want you to know that I am always open to talking about the
topics whenever they are relevant." (Cardemil & Battle, 2003)
Intra-counseling Dimensions

51.  Race
 Ethnicity
 Culture
 Gender
 Social Class
 Sexual Orientation
 Religious Orientation
 Disability
 Geographic Location
 Immigration Status
 Linguistic Diversity
 Body size
Sample Broaching Statement: "Often I ask my
clients about their racial and ethnic background
because it helps me have a better understanding
of who they are. Is that something you'd feel
comfortable talking about?" Cardemil & Battle (2003)
Intra-individual Dimensions

52. Intra-Cultural Dimensions
 Intra-Racial, -Ethnic, and -Cultural dimensions refer more to
sociocultural or within group issues that may arise between
the client and people with whom he or she shares a
common heritage. That is, the client may have personal
beliefs, value orientations, and behaviors that are at odds
with values and viewpoints sanctioned by their cultural
group (e.g. bicultural socialization).
Sample Broaching Statement: Marisol, it sounds like
you are feeling rejected by your friends because
they say you are not Hispanic enough. Is that your
sense of what is going on?

53.  Inter-Racial, -Ethnic, and -Cultural dimensions refer to
efforts to help the client negotiate cultural differences
between her- or himself and people from at least one
other racial, ethnic, or cultural group. This would also
include efforts to help the client negotiate encounters
with the sociopolitical dynamics of racism,
discrimination, oppression, and powerlessness.
Sample Broaching Statement: What has it been like
for you as a gay Latino male to work in an
organization that is inhospitable to sexual
minorities?
Inter-Cultural Dimensions

54.  As clients take risks of talking about intra-
individual, intra-cultural, and inter-cultural
experiences of privilege and oppression, it’s
critical to go back to the intra-counseling
dimension and check in.
Sample Broaching Statement: Today we have
been talking about your sense that many of your
coworkers are prejudiced. What has this
conversation with me been like for you? What
has it been like for you to share experiences of
discrimination with a White therapist who hasn’t
had those kinds of experiences?
Intra-Counseling (again?)

55. Broaching, or Micro-aggressions?
 Counselor trainee conducts a broaching interviewee with
her best friend. The trainee is Caucasian female and the
interviewee is a person of color. In an effort to address
Intra-Counseling Dimensions, the interviewee says:
 “I’m a White woman and you’re a Hispanic girl.”
 Counselor trainee conducts a broaching interview with
her fiancé’s co-worker, who is Korean-American. She
makes an effort to open the session and states:
 “Your English is really good, I can tell, so – when did your
family come here?”

56. 56
 Client's Racial
Identity
Functioning
 Client's Response to
Counselor's Broaching
Effort
 Counselor Considerations
 Low
Commitment
Levels
 May reject counselor’s
invitation to broach
 May have Low Salience
attitudes about Race
 Accept and explore the
client’s reaction to issues of
race and representation
 May help prepare the
client to deal effectively
with racist encounters
 Strong
Commitment
Levels
 May have strong reactions
to counselor's broaching
efforts
 Do not personalize client
reactions
 Identify experiences that
may have led to strong
reactions
 Develop interventions that
help client function more
effectively
 Balanced
Racial Identity
Levels
 May appreciate
counselor’s willingness to
explore how race shapes
their presenting problems
 Broach using
recommended guidelines

57. Broaching competencies
Day-Vines et al., 2007
 Ability to broach depends on
 The counselor’s ability to consider how
sociopolitical factors influence the client's
counseling concerns
 “The therapist must learn to recognize clients’ cultural
meaning attached to phenomena and to subsequently
translate that cultural knowledge into meaningful practice
that facilitates client empowerment, strengthens the
therapeutic alliance, and enhances counseling
outcomes.”
 Ability to manage their own self-of-counselor
reactions effectively to remain open, other-
centered, and engaged.

58. Basic Counseling Skills
 Ability to ask open-ended questions
 Ability to reflect content and affect
 Ability to use foundational counseling skills
Ego Strength
 Ability to manage client values, viewpoints, and experiences that may
differ from one's own
 Healthy level of racial identity functioning
Multicultural Case Conceptualization Skills
 Ability to differentiate between universal and culture-specific issues
 Ability to recognize client strengths as opposed to client deficits
 Ability to identify/state/discuss the impact of sociopolitical issues on the
client (racism, discrimination, power, powerlessness, oppression, privilege)
 Ability to gauge own/client's level of racial identity functioning
 Ability to identify culturally relevant strategies and interventions
Broaching competencies

59. Broaching’s role in treatment
 Validate the client’s concerns
 Empower client
 Affirm client’s competence
 Accept the feelings and meanings client attaches to
problem situation
 Identify client strengths and resources)
 Discuss the sociopolitical basis of the client's
concerns
 Generate broaching statements & questions in an effort
to translate observations into effective clinical dialogue
 Engage in multicultural case conceptualization

60. Broaching’s role in treatment
 Explore relevant cultural dimensions with the
client
 Brainstorm possible coping mechanisms, solution
attempts, response strategies in a culturally
appropriate context
 Evaluate consequences of each strategy
 Determine implementation strategy
 Implement and review effectiveness of the plan

61. There is no easy road!
Acknowledge
Difference
Defensive; in denial
Guilt; shame; hurt
exhaustion, burn-out
Don’t Acknowledge
Difference
 Oblivious; ignorant
 Angry; resentful of
having to be “PC”
 Support status quo
avoidance, denial
• “A counselor’s refusal to both develop and
exercise multicultural counseling competence
represents a potential act of malfeasance
toward clients.” (D. Sue & Sundberg, 1996).

62. We can be recipients as well as
perpetrators of microaggressions
 We must recognize that we all share both
 a common humanity AND
 particular social identities
 which accord power in unbalanced ways
 “ Bridging this power divide is at the heart of
healing divisions”http
://www.racialequitytools.org/resourcefiles/cushing.pdf
 By engaging in the process of ally development,
we can enhance our self-care

63. Practice
 How do you identify
your
 Gender
 Race
 Ethnicity/geography
 Age
 SES/Class
 Education level
 Dis/ability or health
status
 Religion/spirituality
 Body shape/size
 Education level
 What words would you
use with clients?
 “As a ____”
 “I’ve grown up in/as
______”
 “As someone with a
background in/from
______”
 “My experience as
_____”
 “Coming from the
perspective of ____”
 “We both have ____ in
common”

64. Practice
 “As a ____”
 “I’ve grown up in/as
______”
 “As someone with a
background in/from
______”
 “My experience as
_____”
 “Coming from the
perspective of ____”
 “We both have ____ in
common”
 “… I don’t have the
experience of ____”
 “…I probably can’t fullly
understand what it’s like for
you as ____”
 “…we probably have a lot
of differences in terms of
_____”
 “…there’s probably a lot of
things I don’t get about
____”
 “… we probably have a lot
of differences in terms of
____ that are important
too.”

65. Guided Practice
 In a counseling session with Mrs. Pierce, Pedro, a 16 year
old Mexican American male seeks support due to stress
and anxiety about the wild fires in California. The fires
have resulted in the loss of his family's home. Pedro is
finding difficulty focusing in class not only because of
the wild fires, but also from anxiety concerning his
parents' reported losses to their insurance company.
Pedro is afraid that the claim may expose family
immigration secrets: Pedro's father is in the U.S. on an
expired work visa, his mother arrived illegally in the U.S.,
while Pedro and his siblings were born on U.S. soil. His
extended family members have experienced recent
immigration raids that have made him feel increased
levels of vulnerability.

66. Discussion Questions
How might the counselor's attitudes about immigration
influence her/his ability to broach racial and cultural
factors with Pedro?
What might you need to learn in order to work more
effectively with Pedro?
Distinguish between Pedro's universal (etic) and culture-
specific (emic) concerns?
What culture specific concerns should the counselor
address with Pedro?
Generate some sentence stems that will help you
broach racial and cultural factors with Pedro.