Cultural genogram symbols

3

Multicultural Assessment: Understanding Lives in Context

I am I plus my circumstances.

—Jose Ortega y Gasset (1961)

Paolo: You think you understand, but you don’t. [Turns his body away

from his wife and continues speaking.] You’re not Italian.

Karen: You always say that when you don’t agree with me. [Her face

reddens.]

Lillian: Can you tell us more?

Karen: I know that Paolo and I have cultural differences. [Takes a tissue

and continues.] But I mean something else. [Places the tissue on her lap.]

I’m talking about our problems as a couple.

Paolo: What? [Leans forward in his chair.]

Karen: [Slapping the arm of her chair with every word she utters.] You –

don’t – have – time – for – us. We’re always with your family.

Paolo: I don’t get it. [Lowers his voice.] My family is your family.

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http://dx.doi.org/10.1037/13491-003 Multicultural Care: A Clinician's Guide to Cultural Competence, by L. Comas-Díaz Copyright © 2012 American Psychological Association. All rights reserved.

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Karen: I married you, not the Verdis.

Paolo: You’re wrong. [Voice echoes throughout the office.] You married the Verdis. The whole clan.

How do you feel about Paolo and Karen’s couples’ session? What are

the issues Lillian must deal with? How would you approach Paolo and

Karen if they were your clients? Is there a cultural conflict? If so, what do

you think it is?

This clinical vignette illustrates a cultural difference regarding family

boundaries. Karen, a White American woman whose ancestry is British,

seems to perceive the couple as a separate unit. Conversely, Paolo—an

Italian American—sees the couple as part of his family of origin. This dif-

ference demonstrates the contrast between individualistic and collectivist

worldviews.

As readers may remember from Chapter 1, the essential difference

between the individualistic and the sociocentric perspective is the relative

importance people assign to context. In other words, Paolo’s sociocentric

view of marriage as part of his extended family contrasts with Karen’s indi-

vidualistic perception.

Regardless of a clinician’s worldview orientation, he or she can benefit

from paying attention to clients’ multiple contexts. To achieve this goal, you

can complement the explanatory model of distress (see Chapter 2) with a

process-oriented clinical assessment. In this chapter, I discuss multicultural

assessment. Although there is some overlap between the previous chapter

and this one, I emphasized initial engagement and cross-cultural commu-

nication in Chapter 2, whereas here I emphasize gathering and analyzing

information for assessment and treatment. Nonetheless, the tools presented

in this chapter will yield information useful for engagement, and the tools

used in engagement will strengthen assessment.

MULTICULTURAL ASSESSMENT: A PROCESS-ORIENTED APPROACH

A multicultural clinical assessment is a process-oriented approach that

examines the multiple contexts in people’s lives. This clinical process can

MULTICULTURAL CARE

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