Cultural genogram symbols

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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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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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be used for both evaluation and treatment. Engaging in a multicultural

assessment conveys genuine interest in a client and thus fosters a culturally

holding environment. Of course, not all of the contexts may be relevant to

a client’s current circumstances. As with any multicultural strategy, remem-

ber to rely on clinical judgment when conducting a multicultural assess-

ment. I recommend that you ask your clients to have a physical examination.

Because many multicultural individuals are referred to mental health treat-

ment by their internist, your clients may have already undergone a physical

evaluation. Such an examination is helpful in identifying physical condi-

tions, such as thyroid malfunctioning, that may mimic mental health prob-

lems. Moreover, you will be exploring your clients’ health status in a holistic

multicultural assessment.

Individuals’ circumstances may be explored throughout the evaluation

and treatment phases. Indeed, some culturally different clients require an

extended time to share their stories (Mollica & Lavalle, 1988) and for cli-

nicians to earn clients’ trust and demonstrate cultural credibility. The use

of a multicultural assessment demonstrates cultural integrity on the part of

the clinician and enhances the emergence of a therapeutic alliance.

Exhibit 3.1 lists overlapping areas that you may want to consider when

using a multicultural assessment. This is not an exhaustive list. Moreover,

many contextual areas relevant to assessment are not mutually exclusive.

Some of the diversity variables acquire more prominence than others for

certain individuals. For example, although gender may be a pivotal vari-

able for most women, the ethnic/racial–gender interaction achieves cen-

trality in the lives of many women of color. Clinicians can elicit the

contextual information throughout several evaluation sessions as well as

during the treatment phase.

MULTICULTURAL ASSESSMENT DOMAINS

The multicultural assessment examines the contextual areas through four

domains: ethnocultural heritage, journey, self-adjustment, and relations

(Jacobsen, 1988). In the following sections, I discuss the four domains

separately.

MULTICULTURAL ASSESSMENT

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MULTICULTURAL CARE

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Exhibit 3.1

Multicultural Clinical Assessment Areas

Ability and Disability Status

� Cultural beliefs around disability

� Family beliefs, attitudes

Acculturation

� Assimilation

� Biculturalism

� Culture shock stages

� Transculturation

Age

� Age cohort

� Cultural meaning of age

� Interaction of age with gender, ethnicity, race, class, and other

variables

Biocultural

� Health status

� Medical history

� Illnesses, genetic predisposition to illness

� Nutrition, common foods, vitamins, herbs

� Physical activity

� Substance use or abuse

� Traditional healing practices

Development

� Cultural meaning of developmental stages: infancy, childhood,

adolescence, menarche, adulthood, menopause, old age

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MULTICULTURAL ASSESSMENT

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Exhibit 3.1

Multicultural Clinical Assessment Areas (Continued)

Discrimination

� Anti-immigration movement, classism, racism, heterosexism,

ageism, ableism, sizeism, colorism, xenophobia

� Historical and contemporary oppression

� Microaggressions

Education

� Education level

� Occupation, avocation

� Professional status

Ethnicity

� Ethnic identity and identification

� Ethnocultural heritage

� History of (im)migration and generations from (im)migration

� Acculturation and transculturation

� Languages spoken by client, family of origin, and current family

Family

� Adoption and foster parenting

� Family of origin and multigenerational history

� Family life-cycle development and stages

� Family structure (patriarchal, matriarchal, egalitarian; nuclear,

extended; traditional; reconstituted)

� Non–blood-related extended family members, such as padrino,

madrina (godparents), doula (person who mothers the mother

by providing specialized maternal infant care, including emo-

tional and practical support)

(continued)

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