This page is from a web site for intercultural counsellors in Canada: how to help immigrant families overcome the stress symptoms due to loss of cultural identity.
The author is Honoré France, professor at the University of Victoria.

 

ED-D 480/519N CROSS CULTURAL COUNSELLING

 

CRITICAL INCIDENT DISCUSSION ASSIGNMENT

HELPING THESE PEOPLE

One of the most difficult cases I have ever treated was that of an East Indian family in Victoria. Idiman was a 56-year-old recent immigrant to Canada. He had been married some 35 years to Devi, his wife, and had fathered ten children. Only four of his children, three sons and one daughter, resided with him.

Idiman was born in a small village in India and resided there until three years ago when he moved to Canada. He was not unfamiliar with Canada, having worked as a "farm worker" for most of his adult life. The family resided in a small, old, unpainted, rented house on the back of a dirt lot that was sparsely furnished with their belongings. The family did not own a car nor was public transportation available in their neighborhood. While their standard of living was far below poverty levels, the family appeared quite pleased at their relative affluence when compared with their life in India. The presenting complaints concerned Idiman. He heard threatening voices, was often disoriented, stated the belief that someone was planning to kill him, and that something evil was about to happen. He became afraid to leave his home, was in poor physical health, and possessed a decrepit appearance, which made him essentially unemployable. When the family entered the clinic, I was asked to see them because the bilingual therapist scheduled that day had called in sick. I was hoping that either Idiman or Devi would speak enough English to understand the situation. As luck would have it, neither could understand me, nor I them. It became apparent, however, that the two older children could understand English. Since the younger one seemed more fluent, I called upon him to act as a translator during our first session. I noticed that the parents seemed reluctant to participate with the younger son and for some time the discussion between the family was quite animated. Sensing something wrong and desiring to get the session underway, I interrupted the family and asked the son who spoke the best English, what was wrong. He hesitated for a second, but assured me everything was fine. During the course of our first session, it became obvious to me that Idiman was seriously disturbed. He appeared frightened, tense, and, if the interpretations from his son were correct, hallucinating. I suggested to Devi that she consider hospitalizing her husband, but she was adamant against this course of action. I could sense her nervousness and fear that I would initiate action in having her husband incarcerated. I reassured her that no action would be taken without a follow-up evaluation and suggested that she return later in the week with Idiman. Devi said that it would be difficult since Idiman was phobic about leaving his home. She had had to coerce him into coming this time and did not feel she could do it again. I looked at Idiman directly and stated, "Idiman, I know how hard it is for you to come here, but we really want to help you. Do you think you could possibly come one more time? Dr. Singh (the bilingual therapist) will be here with me, and he can communicate with you directly." The youngest son interpreted. The family never returned for another session and their failure to show up has greatly bothered me. Since that time I have talked with several Hispanic psychologists who have pointed out cross-cultural issues that I was not aware of then. Some questions which I have since asked myself are listed below for your consideration.

Questions

1. Was it a serious blunder for me to see the M. family or to continue to see them in the session when I could not speak Hindi? Should I have waited until Dr. Singh returned?

2. At the time it seemed like a good idea to have one of the children interpret for me and the family. What possible cultural implications might this have in the East Indian family? Do you think one can obtain an accurate translation through family interpreters? What are some of the pitfalls?

3. I tried to be informal with the family in order to put them at ease. Yet, some of my colleagues have stated that how I address clients (last names or first names) may be important. When I used the first names of both husband and wife, what possible cultural interpretation from the family may have resulted?

4. I saw Idiman's symptoms as indications of serious pathology. What other explanations might I have entertained? Should I have so blatantly suggested hospitalization? How do East Indians perceive mental health issues?

5. Knowing that Idiman had difficulty leaving home, should I have considered some other treatment avenues? If so, what may they have been?

EQUALITY OF RELATIONSHIPS

Esteban and Carmen O., a Salvadorian couple, sought help at a community mental health clinic in the Vancouver area. Mr. O. had recently come to Canada with only a high school education, but had already acquired several successful printing shops. Carmen, his wife, was born and raised in Florida and came to Canada recently. The two had a whirlwind courtship that resulted in a marriage after only a three-month acquaintance. She described her husband as being outspoken, confident, and a strong person who could be affectionate and sensitive. Carmen used the term "machismo" several times to describe Esteban. The couple had sought counseling after a series of rather heated arguments over his long work hours and his tendency to "go drinking with the boys" after work. She missed his companionship, which was constantly present during their courtship, but now seemed strangely absent. Carmen, who had graduated from UBC with a BA in business, had been working as a secretary and was on the verge of being promoted to an administrative assistant when she met Esteban. She resigned her position prior to her marriage, with the urging of Esteban who stated that "it was beneath her" and that he was capable of supporting both of them. Both had agreed to seek outside help with their marital difficulties, and they had been assigned to Dr. Carla B., a White woman psychologist. The initial session with the couple was characterized by Esteban doing most of the talking. Indeed, Dr. B. was quite put off by what she characterized as Esteban's arrogant attitude. He frequently spoke for this wife and interrupted Dr. B. often, not allowing her to finish questions or make comments. Esteban stated that he understood his wife's desire to spend more time with him, but that he needed to seek financial security for "my children." While the couple did not have any children at the present time, it was obvious that Esteban expected to have many with his wife. He jokingly stated, "After three or four boys, she won't have time to miss me." It was obvious that his remark had a strong impact on Carmen as she appeared quite surprised. Dr. B., who during this session had been trying to give Carmen an opportunity to express her thoughts and feelings, seized the opportunity. She asked Carmen how she felt about having children. As Carmen began to answer, Esteban blurted out quickly, "Of course, she wants children. All women want children."

At this point Dr. B. (obviously angry) confronted Esteban about his tendency to answer or speak for this wife and the inconsiderate manner in which he kept interrupting everyone. Why aren't you at home caring for your husband? What you need is a real man." While Dr. B. did not fall for what she considered to be a baiting tactic she was, nevertheless, quite angry. The session was terminated shortly thereafter. During the next few weeks, Carmen came alone to the sessions without her husband, who refused to return. Their sessions consisted of dealing with Esteban's sexist attitude and the ways she could be her "own person." Dr. B. stressed the fact that Carmen had an equal right in the decisions made in the home, that she should not allow anyone to oppress her, that she did not need her husband's approval to return to her former job, and that having children was an equal and joint responsibility. During this period, the couple separated from one another. It was a difficult period for Carmen who came for therapy regularly to talk about her need "to be my own person," a phrase used often by Dr. B. Carmen and Esteban finally divorced after only a year of marriage.

Questions:

1. What equalitarian attitude held by the therapist may be in conflict with Salvadorian values concerning male-female relationships and the division of responsibilities in the household? Are these values sexist?

2. Is it right to impose one's values and beliefs upon a culturally different group no matter how strongly we believe in them (women should have equal rights and not be oppressed)?

3. How might the gender of the counselor affect his/her credibility when working with culturally different clients? In this case, what Salvadorian cultural values might make it difficult for Esteban to see a White female psychologist?

4. What does the concept "machismo" mean?

5. If you were the counselor, what course of action would you take? Why?

ASSERT YOURSELF

Sylvia Echohawk is a 29-year-old First Nations woman who works for one of the major automobile manufacturing companies in Ontario. The company has recently implemented an affirmative action program designed to open up jobs for minorities. The personnel director, a White male counseling psychologist, is in charge of it. Sylvia, who was hired under the affirmative action program, is referred to him by her immediate supervisor because of "frequent tardiness." Also, the supervisor informs the psychologist that other employees take advantage of Sylvia. She goes out of her way to help them, shares her lunches with them, and even lends them money. Several times during the lunch hours, other employees have borrowed her car to run errands. The supervisor feels that Sylvia needs to actively deal with her passive-aggressive means of handling anger (tardiness), to set limits on others, and to be able to assert her rights.

In an interview with Sylvia, the psychologist notices several things about her behavior. She is low-keyed, restrained in behavior, avoids eye contact, and finds it difficult to verbalize her thoughts and feelings. After several meetings, the psychologist concludes that Sylvia would benefit from assertion training. She is placed in such a group during regular working hours but fails to show up for meetings after attending the first one. Additionally, Sylvia's supervisor informs the psychologist that she has turned in a two-week resignation notice.

Questions

1. Is it possible that First Nations communication styles are leading to inaccurate assumptions made by the counselor?

2. In what ways would the following values shared by First Nations affect both the work setting and counseling approach (cooperation, sharing, temporal perspective, and harmony)?

3. What does an affirmative action program mean? What does it mean to you? How do you feel about it?

4. What obligations do organizations have in adapting their practices to fit the needs of culturally different workers? What obligations does the culturally different worker have to adjust?

5. What can be done on both an individual and institutional level to help Silver?

WINNING ISN'T EVERYTHING--IT'S THE ONLY THING

Janet Myers was having problems with Johnny Lonetree and Peter Hawk, two First Nations students in her class. They did not appear unintelligent, but were quite withdrawn, sullen, and passive. What irked her most was their tendency to always appear late, thereby interrupting her lectures. They seldom participated in class and when called upon would make irrelevant and tangential contributions. Because Ms. Myers graded on contributions and discussions from students, both Johnny and Peter did poorly in point accumulations. Even her attempts to explain the "bell"-shaped curve to them for grading failed to change their lack of involvement in the course. The point totals and grades were always posted in a notebook open to student inspection. Ms. Myers knew the two students would fail unless a miraculous change occurred. The next half of the course consisted of a series of debates among "hypothetical philosophers" role-played by groups of students. For example, the class would be divided into teams representing philosophers like Aristotle, Socrates, Plato, and so forth, who would debate each other over issues of life. Scores obtained by teams were dependent upon an individual student's being able to win a point over his/her classmate counterpart. Perhaps Johnny and Peter will be able to do better in this method of learning.

Questions

1. What First Nations cultural values may be in direct conflict with educational values?

2. How would you characterize the teaching method by Ms. Myers? Is it representative of our education system?

3. What form of teaching might the teacher consider that would be more consistent with First Nations values?

4. What responsibilities should professors and our education institutions exercise to provide alternative methods of learning in our pluralistic society?

5. If you could devise a culturally sensitive educational approach for American Indians, what would it consist of?

CULTURE CONFLICT

David Chan is a 21-year-old student majoring in electrical engineering. He first sought counseling because he was having increasing study problems and was receiving failing grades. These academic difficulties became apparent during the first quarter of his senior year and were accompanied by headaches, indigestion, and insomnia. Since he had been an excellent student in the past, David felt that his lowered academic performance was caused by illness. However, a medical examination failed to reveal any organic disorder. During the initial interview, David seemed depressedand anxious. He was difficult to counsel because he would respond to inquiries with short, polite statements and would seldom volunteer information about himself. He avoided any statements that involved feelings and presented his problem as strictly an education one. Although he never expressed it directly, David seemed to doubt the value of counseling and needed much reassurance and feedback about his performance in the interview. After several sessions, the counselor was able to discern one of David's major concerns. David did not like engineering and felt pressured by his parents to go into this field. Yet, he was unable to take responsibility for any of his own actions, was excessively dependent on his parents, and was afraid to express the anger he felt toward them. Using the Gestalt "empty chair technique," the counselor had David pretend that his parents were seated in empty chairs opposite him. The counselor encouraged him to express his true feelings toward them. While initially he found it very difficult to do, David was able to ventilate some of his true feelings under constant encouragement by the counselor. Unfortunately, the following sessions with Dave proved unproductive in that he seemed more withdrawn and guilt-ridden than ever.

Questions

1. What cultural forces may be affecting David's manner of expressing psychological conflicts?

2. What possible unwarranted interpretations are being made about David Chan?

3. What stereotypes do you have about Canadians of Asian decent? How many stereotypes affect the holder of the stereotypes' attitudes and behaviors? How may they affect the minority individual?

4. How may the counseling techniques used by the counselor clash with the traditional Asian cultural values? With what effect?

5. If you were the counselor, what course of action would you take? Why?

WHO'S TO BLAME

Felix Sanchez is a second-generation, 19-year-old freshman attending a major university in BC He is the oldest of five siblings, all currently residing in the USA Felix's father works as a delivery driver for a brewery, and his mother is employed part-time as a housekeeper. Both parents have worked long and hard to make ends meet and have been instrumental in sending their eldest son to college. Felix is the first in his entire family (including relatives) to have ever attended an institution of higher education. It is generally understood that the parents do not have the financial resources to send Felix's other brothers and sisters to college. If they are to make it, they would need to do it on their own or obtain help elsewhere. As a result, Felix found a part-time job without the knowledge of his parents in order to secretly save money for his siblings' future education. During the last two quarters, Felix has been having extreme difficulties in his classes. Felix's inability to obtain grades better than C's or D's greatly discouraged him. Last quarter, he was placed on academic probation and the thought of failing evoked a great sense of guilt and shame in him. While he had originally intended to become a social worker and had looked forward to his course work, he now felt depressed, lonely, alienated, and guilt-ridden. It was not so much his inability to do the work, but the meaninglessness of his courses, the materials in the texts, and the manner in which his courses were taught. Worse yet, he just could not relate to the students in his dormitory and all the rules and regulations. At the beginning of his last quarter, Felix was referred by his EOP adviser to the university counseling center. Felix's counselor, Mr. Blackburne, seemed sincere enough but only made him feel worse. After several sessions, the counselor suggested possible reasons for Felix's inability to do well in school. First, it was possible that he was "not college material" and had to face that fact. Second, his constant "sacrificing" of his time (part-time work) to help his siblings contributed to his poor grades. Third, Felix's depression and alienation was symptomatic of deeper more serious intrapsychic conflicts.

Questions

1. In what ways may the counselor be blaming Felix (as an individual) rather than external forces as the cause of his problems?

2. How may teaching styles, material and text used, and so forth, be the source of Felix's feeling of loneliness, isolation, depression, and meaninglessness?

3. How may institutional rules and regulations clash with concepts of "personalismo?"

4. Is the counselor perceiving traditional Hispanic family obligation as a source of deficit? What evidence do we have of this, and what effect might it have on Felix?

5. If you were the counselor, what course of action would you take? Why?