Posted: July 17th, 2022

Multicultural Social Work Practice

Derald Wing Sue

JOHN WILEY & SONS, INC.

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Multicultural Social Work Practice

Multicultural Social Work Practice

Derald Wing Sue

JOHN WILEY & SONS, INC.

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Foreword xiii Preface xvii

Part I The Conceptual Dimensions of Multicultural Social Work Practice 1

Chapter 1 Principles and Assumptions of Multicultural Social Work Practice 3

The Diversification of the United States and Implications for Social Work 4 The Graying of the Workforce and Society 4

The Feminization of the Workforce and Society 5

The Changing Complexion of the Workforce and Society 6

Cultural Diversity and the Challenge to Social Work 7 Theme One: Cultural Universality versus

Cultural Relativism 10

Theme Two: The Emotional Consequences of “Race and/or Differences” 11

Theme Three: The Inclusive or Exclusive Nature of Multiculturalism 12

Theme Four: The Sociopolitical Nature of Social Work Practice 13

Theme Five: The Nature of Culturally Competent Social Work Practice 14

The Multiple Dimensions of Human Existence 15 Individual and Universal Biases in Social Work 18 What Is Multicultural Social Work Practice? 20

CONTENTS

v

Chapter 2 Becoming Culturally Competent in Social Work Practice 23

Defining Cultural Competence in Social Work Practice 23 The Four Components of Cultural Competence 24

Competency One: Becoming Aware of One’s Own Assumptions, Values, and Biases about Human Behavior 25

Competency Two: Understanding the Worldview of Culturally Diverse Clients 26

Competency Three: Developing Appropriate Intervention Strategies and Techniques 27

Competency Four: Understanding Organizational and Institutional Forces that Enhance or Negate Cultural Competence 28

A Working Definition of Cultural Competence 29 Multidimensional Model of Cultural Competence in Social Work 30

Dimension I: Group-Specific Worldviews 32

Dimension II: Components of Cultural Competence 32

Dimension III: Foci of Social Work Interventions 37

Implications for Social Work Practice 38

Part II The Political Dimensions of Social Work Practice 41

Chapter 3 Understanding the Sociopolitical Implications of Oppression in Social Work Practice 43

Effects of Historical and Current Oppression 47 Ethnocentric Monoculturalism 49

Belief in Superiority 50

Belief in the Inferiority of Others 50

Power to Impose Standards 51

Manifestation in Institutions 51

The Invisible Veil 52

Historical Manifestations of Ethnocentric Monoculturalism 53 Impact of Ethnocentric Monoculturalism in Helping Relationships 55

vi Contents

Credibility and Attractiveness in Multicultural Social Work Practice 57 Credibility of Social Worker 57

Implications for Social Work Practice 61

Chapter 4 Sociopolitical Dimensions of Worldviews 63

The Formation of Worldviews 65 Value Orientation Model of Worldviews 66

Locus of Control 68

Locus of Responsibility 71

Formation of Worldviews 73 Internal Locus of Control (IC)–Internal Locus of Responsibility (IR) 74

External Locus of Control (EC)–Internal Locus of Responsibility (IR) 77

External Locus of Control (EC)–External Locus of Responsibility (ER) 78

Internal Locus of Control (IC)–External Locus of Responsibility (ER) 80

Part III Racial/Cultural Identity Development: Social Work Implications 85

Chapter 5 Racial/Cultural Minority Identity Development 87

Racial/Cultural Identity Development Models 88 Black Identity Development Models 89

Other Racial/Ethnic Identity Development Models 90

Feminist Identity Theory 91

A Working Racial/Cultural Identity Development Model 92 Conformity Stage 93

Dissonance Stage 98

Resistance and Immersion Stage 99

Introspection Stage 101

Integrative Awareness Stage 103

Social Work Implications of the R/CID Model 104

Contents vii

Chapter 6 White Racial Identity Development 107

What Does It Mean to Be White? 107 42-year-old White Business Man 107

26-year-old White Female College Student 108

65-year-old White Male Retired Construction Worker 108

34-year-old White Female Stockbroker 108

29-year-old Latina Administrative Helpant 109

39-year-old Black Male Salesman 109

21-year-old Chinese American Male College Student (majoring in ethnic studies) 110

The Invisible Whiteness of Being 110 Understanding the Dynamics of Whiteness 112

Models of White Racial Identity Development 114 The Hardiman White Racial Identity Development Model 115

The Helms White Racial Identity Model 117

The Process of White Racial Identity Development: A Descriptive Model 120 Conformity Phase 122

Dissonance Phase 123

Resistance and Immersion Phase 125

Introspection Phase 126

Integrative Awareness Phase 127

Implications for Social Work Practice 127

Part IV The Practice Dimensions of Multicultural Social Work 129

Chapter 7 Barriers to Effective Multicultural Clinical Practice 131

Generic Characteristics of Counseling/Therapy 135 Sources of Conflict and Misinterpretation in Clinical Practice 138

Culture-Bound Values 138

Class-Bound Values 145

Language Barriers 148

viii Contents

Generalizations and Stereotypes: Some Cautions 149 Implications for Social Work Practice 150

Chapter 8 Cultural Styles in Multicultural Intervention Strategies 153

Communication Styles 155 Nonverbal Communication 156

Proxemics 157

Kinesics 158

Paralanguage 160

High-/Low-Context Communication 162

Sociopolitical Facets of Nonverbal Communication 164 Nonverbals as Reflections of Bias 165

Nonverbals as Triggers to Biases and Fears 167

Differential Skills in Multicultural Social Work Practice 170 Implications for Social Work Practice 171

Chapter 9 Multicultural Family Counseling and Therapy 173

Family Systems Approaches and Assumptions 179 Issues in Working with Ethnic Minority Families 181

Ethnic Minority Reality 181

Conflicting Value Systems 182

Biculturalism 182

Ethnic Differences in Minority Status 183

Ethnicity and Language 185

Ethnicity and Social Class 186

Multicultural Family Social Work: A Conceptual Model 187 People-Nature Relationship 188

Time Dimension 189

Relational Dimension 191

Activity Dimension 192

Nature of People Dimension 194

Implications for Social Work Practice 195

Contents ix

Chapter 10 Non-Western and Indigenous Methods of Healing 199

Spirit Attacks: The Case of Vang Xiong 199 Symptoms and Cause 200

Shamanic Cure 200

The Legitimacy of Culture-Bound Syndromes: Nightmare Deaths and the Hmong Sudden Death Phenomenon 201

Causation and Spirit Possession 203 The Shaman as Therapist: Commonalities 206

A Case of Child Abuse? 207

The Principles of Indigenous Healing 211 Holistic Outlook, Interconnectedness, and Harmony 213

Belief in Metaphysical Levels of Existence 216

Spirituality in Life and the Cosmos 217

Conclusions 220 Implications for Social Work Practice 220

Part V Systemic and Ecological Perspectives of Multicultural Social Work 225

Chapter 11 Multicultural Organizational Change and Social Justice 227

Monocultural versus Multicultural Organizational Perspectives in Social Work 229 Lesson One: A failure to develop a balanced perspective between person focus

and system focus can result in false attribution of the problem. 231

Lesson Two: A failure to develop a balanced perspective between person focus and system focus can result in an ineffective and inaccurate treatment plan that is potentially harmful toward the client. 232

Lesson Three: When the client is the “organization” or a larger system and not an “individual,” it requires a major paradigm shift to attain a true understanding of problem and solution identification. 232

Lesson Four: Organizations are microcosms of the wider society from which they originate. As a result, they are likely to be reflections of the monocultural values and practices of the larger culture. 233

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Lesson Five: Organizations are powerful entities that inevitably resist change and possess within their arsenal many ways to force compliance in individuals. 233

Lesson Six: When multicultural organizational development is required, alternative helping roles that emphasize systems intervention must be part of the role repertoire of the social worker. 234

Lesson Seven: Although remediation will always be needed, prevention is better. 234

Models of Multicultural Organizational Development 235 Culturally Competent Social Service Agencies 238 The Social Justice Agenda of Multicultural Social Work 242 Antiracism as a Social Justice Agenda 245

Principle One: Having Intimate and Close Contact with Others 246

Principle Two: Cooperating Rather Than Competing 247

Principle Three: Sharing Mutual Goals 248

Principle Four: Exchanging Accurate Information 248

Principle Five: Sharing an Equal Relationship 249

Principle Six: Supporting Racial Equity by Leaders and Groups in Authority 251

Principle Seven: Feeling Connected and Experiencing a Strong Sense of Belonging 251

Social Work Must Advocate for Social Change 253

Part VI Profiles in Culturally Competent Care for Diverse Populations 255

Chapter 12 Profiles of Culturally Competent Care with African American, Asian American, and Native American Populations 257

African American Profile 258 Important Dimensions 258

Asian American Profile 264 Important Dimensions 264

Native American/American Indian Profile 269 Important Dimensions 270

Contents xi

Chapter 13 Profiles of Culturally Competent Care with Biracial/Multiracial, Latino/Hispanic, and Immigrant/Refugee Populations 277

Biracial/Multiracial Profile 277 Important Dimensions 277

Latino/Hispanic American Profile 284 Important Dimensions 285

Immigrants/Refugees Profile 291 Important Dimensions 292

Chapter 14 Profiles of Culturally Competent Care with Women, Sexual Minorities, Elderly Persons, and Those with Disabilities 299

Women Profile 299 Important Dimensions 299

Sexual Minority Profile 306 Important Dimensions 306

Elderly Persons Profile 314 Important Dimensions 315

Persons with Disability Profile 323 Important Dimensions 323

References 331

Author Index 353

Subject Index 359

xii Contents

FOREWORD

xiii

Derald Wing Sue’s book Multicultural Social Work Practice reflectsthe most important underlying principles of social work. These principles have too often been hidden from view by the power dynam- ics of our society. These individualistic and materialistic dynamics make it hard to think or operate in systemic ways that would allow us to be truly open to those who are culturally different and who are continu- ously marginalized without our society.

Dr. Sue’s compelling and comprehensive textbook demonstrates with dramatic clarity the primacy of multicultural issues for social work- ers. He shows that cultural competence is not an add-on to basic social work practice but rather reflects the fundamental principles for under- standing clients and working for social justice. Dr. Sue has spent his en- tire career thinking through issues of multiculturalism, and now he has written what will surely become the classic social work text on the topic.

His clear understanding of the social work principles lies at the very center of his argument that multicultural understanding should be at the absolute core of social work activity. As he demonstrates so artic- ulately, striving toward multiculturalism is crucial to achieving social justice, a goal toward which we all as social workers strive.

This amazing text is interspersed throughout with very rich illus- trative quotations that help to demonstrate typical responses of clients, students, and faculty to issues pertaining to racism, White identity, White privilege, bicultural experiences and so on. One recognizes fam- ily, friends, colleagues, students, and clients in the many examples Dr. Sue has threaded throughout this extraordinary text. His quotes from the entire spectrum of responses to racism and multiculturalism are touching and powerful illustrations of the issues he raises. His case ex- amples are extremely helpful. He challenges us to push past facile no- tions of cultural competence to realize that multicultural thinking is a lifetime educational process, which demands that we undo much of so- ciety’s teaching and open our hearts and our conscience to ways of thinking about the world that have been marginalized in our country for centuries. Dr. Sue covers the length and breadth of the issues in the field, including a summary of his own formulation of the stages of White identity development in the context of others’ descriptions of cultural identity from Black, Latino, and Asian perspectives.

Dr. Sue discusses many of the assumptions of traditional thera- peutic practice: talk, the ambiguity of the context of social worker and client, and the expectation that the client will show insight, practice in- trospection, and reveal personal feelings. He demonstrates most power- fully how these expectations discount the values of the poor, women, and clients from nondominant cultural backgrounds.

Through his lifetime commitment to these issues, Dr. Sue has

gained an extraordinary perspective on the importance of multiculturalism for social work. He raises many questions about monocultural responses to clients who come from different cultural contexts. He is comprehensive in both breadth and depth of his discussion of these issues. He conveys a very broad understanding of the intersection of issues of race, gender, class, and sexual orientation. And at the same time he clearly explains the nuances of cultural interactions.

He discusses the example of Vang Xiong, a Hmong soldier, and his fam- ily, challenging us to go beyond the limitations of traditional diagnostic as- sessment. He challenges us to think outside of the box in order to understand clients whose history and culture may have included traumatic experiences and cultural practices we couldn’t possibly understand without expanding our cultural lens. He urges us to consider the importance of a client’s belief in healing practices that may be very different from traditional mental health approaches. Vang Xiong had the belief that his nightmares and fear of sleep were related to an attack by undesirable spirits because he and his brother had failed to follow all of the mourning rituals they should have performed for their parents years before back in Laos. Both indigenous and Western healing practices were combined to help him overcome his fears. In other cases, children presenting with what appear to be bruises from abuse may have been treated with traditional massage or other healing remedies, and we would be remiss to rely on our own world view for understanding the be- havior and meaning systems of clients from different cultural backgrounds.

Dr. Sue provides a fascinating discussion of the value of shamanic tradi- tions, which we would do well to consider in our work as social workers. For example, the family gods may be invoked, “not to intervene but to grant wis- dom, understanding, and honesty.” The leader may elicit “truth telling,” sanctioned by the gods, and pray for spiritual connection among the family, reaching out to the most resistant family members and attempting to unify and bring harmony to the group. Righting wrongs and creating a context for forgiveness are key principles of the process. Unlike our society’s emphasis on individualism, confidentiality, and intrapsychic processes, indigenous healers in other cultural contexts generally take a much more contextual approach: focusing on rebalancing the person in his or her family and community con- text. The lessons here are important: Our multicultural efforts must begin by challenging the arrogance of our psychological assumptions that we know the best, right, and true methods for assessment and intervention. To become multiculturally competent we must begin by practicing humility, and open our hearts and minds to understanding the wisdom of others. Sue reminds us that there is often a great discrepancy not only in services provided to non- European clients, but between what clients wish for from their doctors and what doctors offer. Perhaps it is not always the clients who are wrong in their expectations. Perhaps we need to attend more to spiritual and contextual as-

xiv Foreword

Foreword xv

pects of healing and not just to the technology of health. As Sue summarizes it in Chapter 10:

Culturally sensitive helping required making home visits, going to community centers, and visiting places of worship and areas within the community. The types of help most likely to prevent mental health problems are building and maintaining healthy connections with one’s family, one’s god(s), and one’s uni- verse. It is clear that we live in a monocultural society—a society that invalidates and separates us from one another, from our spirituality, and from the cosmos. There is much wisdom in the ancient forms of healing that stress that the road to mental health is through becoming united and in harmony with the universe.

Dr. Sue challenges social work to examine the implicit values that have glamorized the clinician conducting practice with individuals in an office en- vironment. He urges us to reconnect with the deeper systemic values of so- cial work, which require us to be also ombudsmen, advocates, consultants, organizational change agents, and facilitators of indigenous healing systems. Otherwise, we are all too likely to end up blaming the victim—focusing our attention on the symptomatic person, rather than on the system, which may have made his or her symptoms an adaptive strategy in response to a patho- logical context. He challenges us to examine the institutions in which we op- erate to assess their level of multicultural organizational development, which can be assessed for cultural destructiveness, cultural incapacity, cultural blindness, or multicultural proficiency and advocacy.

Dr. Sue is to be applauded for doing a spectacular job of writing a lively, clear, and comprehensive text that provides rich material for social work stu- dents, practitioners, and teachers to engage in the essential questions of our time: how we learn to understand and connect with each other across cul- tural borders. You are in for an enjoyable and deeply meaningful challenge as you proceed with this outstanding book.

MONICA MCGOLDRICK, MSW, PHD Director, Multicultural Family Institute of New Jersey Highland Park, NJ

PREFACE

xvii

Multicultural Social Work Practice is a text that presents a balancebetween the need for social workers to understand not only cultural differences reflected in worldviews but also the sociopolitical dimensions of culturally competent care. The major thesis is that social work theories, concepts, and practices are often rooted in and reflect the dominant values of the larger society. As a result, forms of treatment may represent cultural oppression and may reflect primarily a Euro- centric worldview that may do great harm to culturally diverse clients and their communities. In order to be culturally competent, social work professionals must be able to free themselves from the cultural condi- tioning of their personal and professional training, to understand and accept the legitimacy of alternative worldviews, to begin the process of developing culturally appropriate intervention strategies in working with a diverse clientele, and to become aware of systemic forces affect- ing both their clients and themselves.

While the field of social work is not unlike that of most helping professions, it has always been distinguished by its greater community focus, work in community-based agencies, and work with ecological approaches that involve individuals, communities, institutions, public policy. The settings where social workers function are much broader than those of psychology and psychiatry, and they offer an advantaged position to be culturally relevant in the services offered.

Although my background and training have been in counseling psychology, I have always relied heavily on social work philosophy to guide my own work. Many of you may be aware of my work on cultural competence in counseling and psychotherapy and my text on Counsel- ing the Culturally Diverse: Theory and Practice, which was written for men- tal health professionals. Ironically, the success of that book was formed from the philosophical base and principles of culturally competent care derived from social welfare and social work. So it was not a far leap for me to join the Columbia University School of Social Work and to work on a social work text that spoke to the issues of oppressed and margin- alized groups in our society.

Multicultural Social Work Practice speaks to multicultural work with clients (individuals, families, and groups) and client systems (neighbor- hoods, communities, agencies, institutions, and societal policies), re- mediation and prevention, person-environment models, equal access and opportunity, and social justice issues. Like much of my work, it is hard hitting and passionate in tone and, hopefully, represents a wake-up call to the social work and helping professions. It challenges traditional so- cial work practice as culture-bound and calls for cultural competence in practice.

The text focuses equally on what social workers need to acquire to

become culturally competent in working with a diverse population. Most social work texts do not emphasize strongly enough the acquisition of cultural awareness, knowledge, and skills by the social worker. Thus, the concepts of multiculturalism play a central role in the text. Its definition is inclusive and encompasses many sociodemographic categories. A framework that inte- grates individual, group, and universal identities is presented to guide work with diverse populations. Multiculturalism and diversity are viewed as an overarching umbrella to include not only race but also culture, ethnicity, sex- ual orientation, gender, and so on. Use of generous clinical and real-life ex- amples to illustrate the concepts of multicultural social work practice is char- acteristic of each and every chapter. Unlike in many social work texts, specific and precise definitions of multiculturalism, cultural competence, and multi- cultural social work are presented to guide discussion and analysis.

Chapter 1, “Principles and Assumptions of Multicultural Social Work Practice,” provides a strong conceptual and philosophical framework for un- derstanding the meaning of multiculturalism, multicultural social work, and cultural competence. It seeks to tackle hot-button issues related to race, gen- der, sexual orientation, and other group markers. The chapter introduces a tripartite framework for understanding individual uniqueness; group differ- ences related to race, gender, sexual orientation, disability, and so on; and universal similarities. Unlike other texts in social work, it presents working definitions of cultural competence and multicultural social work practice.

Chapter 2, “Becoming Culturally Competent in Social Work Practice,” outlines the four components of cultural competence: (a) becoming aware of one’s own worldview, (b) understanding the worldview of culturally diverse groups, (c) developing culturally appropriate intervention strategies, and (d) understanding the social worker’s roles in relation to organizational and so- cietal forces that either negate or enhance cultural competence. A multidi- mensional model of cultural competence in social work is presented.

Chapter 3, “Understanding the Sociopolitical Implications of Oppres- sion in Social Work Practice,” makes it clear that social work and mental health practices are sociopolitical acts as well. This chapter takes the mental health profession to task by documenting its ethnocentric and monocultural features; by revealing how mental health has historically portrayed racial/ ethnic minorities as pathological; by discussing how mental health practices have oppressed minorities; and by showing how helping professions reflect the larger biases, assumptions, practices, and prejudices of the larger society.

Chapter 4, “Sociopolitical Dimensions of Worldviews,” reveals how race, culture, ethnicity, gender, and sexual orientation influence worldviews. In the field of mental health practice, being able to understand the worldview of your culturally different clients is considered one of the cornerstones of cultural competence.

Chapter 5, “Racial/Cultural Minority Identity Development,” summa-

xviii Preface

rizes research and anedoctal findings to clarify the parameters of the compet- ing theories of racial identity development. While the various theories and their pros and cons are discussed, the major emphasis in this chapter is on presenting an integrative model that describes the various stages or “ego states” and their implications for assessment and therapeutic intervention. Racial/cultural identity development emphasizes between- and within- group differences that social workers must acknowledge if they are to provide culturally relevant services to all groups.

Chapter 6, “White Racial Identity Development,” focuses on White identity development, White privilege, and how the Euro-American world- view affects perception of race-related issues. It is an important component of culturally competent care for White social workers. The thesis of the chap- ter is that White social workers and other mental health professionals (a) must realize that they are victims of their cultural conditioning; (b) have in- herited the racial biases, prejudices, and stereotypes of their forebears; (c) must take responsibility for the role they play in the oppression of minority groups; and (d) must move toward actively redefining their Whiteness in a nondefensive and nonracist manner. Discussion of the interplay between varying levels of White awareness and working with culturally diverse clients is a major part of this chapter.

Chapter 7, “Barriers to Effective Multicultural Clinical Practice,” is di- rectly aimed at clinical practice and casework. It outlines how traditional mental health services are imbued with monocultural assumptions and prac- tices that disadvantage, or deny equal access and opportunities to, culturally diverse groups. Specific case examples and research findings are given to in- dicate how the generic characteristics of counseling and psychotherapy pre- sent problems for racial/ethnic groups. Among these barriers are culture- bound values, class-bound values, and linguistic barriers.

Chapter 8, “Cultural Styles in Multicultural Intervention Strategies,” challenges the universal models of helping and suggests that social workers must begin the process of developing appropriate and effective intervention strategies in working with culturally different clients. This means that tradi- tional clinical practice must accept the notion of culture-specific strategies in the helping process. Differences in communication styles, especially in non- verbal communication are discussed with respect to social work practice. Tra- ditional taboos of Eurocentric counseling and therapy are questioned.

Chapter 9, “Multicultural Family Counseling and Therapy,” stresses several important factors: (a) Most racial/ethnic minorities are collectivistic in orientation and use the family as the psychosocial unit of operation, and (b) social workers need to understand the many different cultural definitions of the family. The basic premise is that the family social worker must be aware of how racial/ethnic minority groups view the family. Not only do groups dif- fer in defining the family (versus the nuclear family), but also roles and

Preface xix

processes differ from Euro-American structures and processes. Specific sug- gestions and guidelines are given to the multicultural family caseworker.

Chapter 10, “Non-Western Indigenous Methods of Healing,” acknowl- edges that all helping originates from a particular cultural context. Within the United States, counseling and psychotherapy are the dominant psychological healing methods; in other cultures, however, indigenous healing approaches continue to be used widely. This chapter begins with a description of the his- toric and continuing “shamanic” practice of healers often called witches, witch doctors, wizards, medicine men or women, sorcerers, or magic men or women. These individuals are believed to possess the power to enter an altered state of con- sciousness and in their healing rituals journey to other planes of existence be- yond the physical world. Implications for social work practice are discussed.

Chapter 11, “Multicultural Organizational Change and Social Justice,” reveals that both clients and social workers function under the umbrella of many institutions: social service agencies, schools, businesses, industries, and municipalities. Social workers are products of their school systems, are em- ployed by organizations, seek health care from the medical establishment, and function under governmentally developed social policies. What happens when the very organizations that educate us, employ us, and police us are monocultural and harm or oppress rather than healing or liberating? This chapter makes a strong case that social workers must also direct their efforts toward organizational change and social justice.

Chapters 12–14 (profiles in culturally competent care for diverse popu- lations) present historical, cultural, and sociopolitical information profiles on 10 culturally diverse groups: African Americans, Asian Americans, Native Americans, biracial/multiracial persons, Latinos/Hispanics, immigrants/refu- gees, women, sexual minorities, elderly people, and persons with disabili- ties. Because of space limitations, other culturally diverse groups, such as those defined by religious orientation, could not be covered. Further, the profile information is presented mainly as guidelines for students to continue their study of the diverse groups in this society. They are not meant as definitive guidelines and if used in such a manner would foster stereotypes. Rather, they are presented here as a resource for further investigation and study.

Working on Multicultural Social Work Practice has proven to be a labor of love. It would not have been possible, however, without the love and support of my family, who provided the patience and nourishment that sustained me throughout the production of the text. I wish to express my love for Paulina, Derald Paul, and Marissa. This book is dedicated to them, a family of color in the United States.

xx Preface

T H E C O N C E P T U A L

D I M E N S I O N S O F M U LT I C U LT U R A L

S O C I A L W O R K P R A C T I C E

PART

I

1

C h a p t e r

3

“A younger probationer (Native American) was under court supervision and had strict orders to remain with responsible adults. His counselor be- came concerned because the youth appeared to ignore this order. The client moved around frequently and, according to the counselor, stayed overnight with several different young women. The counselor presented this case at a formal staff meeting, and fellow professionals stated their suspicion that the client was either a pusher or a pimp. The frustrating element to the counselor was that the young women knew each other and appeared to enjoy each other’s company. Moreover, they were not ashamed to be seen together in public with the client. This behavior prompted the counselor to initiate violation proceedings” (Red Horse, Lewis, Feit, & Decker, 1981, p. 56).

If an American Indian professional had not accidentally come upon this case, a revocation order initiated against the youngster would surely have caused irreparable alienation between the family and the social ser- vice agency. The social worker had failed to realize that the American In- dian family network is structurally open and may include several house- holds of relatives and friends along both vertical and horizontal lines. The young women were all first cousins to the client, and each was as a sister, with all the households representing different units of the family. It is in marked contrast to the Western European concept of the “nuclear family” and what constitutes “family.”

Of all the social sciences and helping professions, the history andlegacy of social welfare and social work have their roots in the values of social justice, aiding marginalized and oppressed populations, service to society, and the dignity and worth of all persons (Lum, 2005; Morales & Sheafor, 2004; National Association of Social Workers, 1999; Zastrow, 2004). The National Association of Social Workers (NASW) makes it explicit in their Code of Ethics (1999) and Standards for Cultural Competence in Social Work Practice (NASW, 2001) that it is unethical to practice without the knowledge, expertise, and skills needed to provide

Principles and Assumptions of Multicultural Social Work Practice

culturally relevant services to an increasingly diverse population. Unfortu- nately, as in the case just described, a wide gap often exists between the stated aspirational standards and ethics of a profession and their implementation in actual practice. One of the main reasons is that social work and, by extension, social workers are no more immune from cultural encapsulation (Wrenn, 1962) than any other profession or professionals in this society. As a result, our education and training often reflect the larger values and biases of the so- ciety. Rather than helping, healing or liberating, social work practice can be guilty of cultural oppression, imposing one group’s worldview (normality versus abnormality, healthy versus unhealthy, and definitions of “family”) on another.

The Diversification of the United States and Implications for Social Work

The disparity in providing culturally appropriate services, as in the example given, is likely to become more problematic unless the profession of social work adapts accordingly to an increasingly diverse population. Nowhere is diversification of society more evident than in the workplace, where three major trends can be observed: (a) the graying of the workforce (Burris, 2005), (b) the feminization of the workforce (Taylor & Kennedy, 2003), and (c) the changing complexion of the workforce (Sue, Parham, & Santiago, 1998).

The Graying of the Workforce and Society

As the baby boomers (those born between 1946 and 1961) head into old age, the population of those 65 and older will surge to 53.3 million by 2020, an in- crease of 63% from 1996 (Study: 2020 Begins, 1996). In 1950, elderly people comprised 8% of the population; in the year 2000, 13%; and by 2050 will comprise 20%. The dramatic increase in the elderly population can be attrib- uted to the aging baby-boom generation, declining birth rates, and increased longevity (Huuhtanen, 1994; Keita & Hurrell, 1994; Sue, Parham, & Santi- ago, 1998). The median age of people in the workforce has risen from 36.6 years in 1990 to 40.6 in 2005. In 2005, it is estimated that 70% of workers will be in the 25–54 age group and the proportion of workers 55 and older will rise to 15%. The implications are many.

� There is a serious lack of knowledge concerning issues of the elderly and the implications of an aging population on social service needs, occu- pational health, quality-of-life issues, economic impact, and mental health needs (see Chapter 13).

4 The Conceptual Dimensions of Multicultural Social Work Practice

� In American society, the elderly suffer from societal beliefs and attitudes (stereotypes) that diminish their social status: According to these stereotypes, they have declining physical and mental capabilities, have grown rigid and inflexible, are incapable of learning new skills, are crotchety and irritable, and should step aside for the benefit of the young (Brammer, 2004; Zastrow, 2004). More important is the belief that their lives are worth less than those of their younger counterparts.

� The elderly are increasingly at the mercy of governmental policies and company changes in social security and pension funds that reduce their benefits and protection as they begin their retirement years.

� Social service agencies are ill prepared to deal with the social and mental health needs of the elderly. Many of these disparities are due to ageism.

The Feminization of the Workforce and Society

Women are increasingly playing a larger and more significant role in society. Over the 15-year period from 1990 to 2005 women came to account for 62% of the net increase in the civilian labor force. The upward trend is dramatic: 38% in 1970, 42% in 1980, and 45% in 1990 (U.S. Department of Labor, Women’s Bureau, 1992). The trend is not confined to single women alone but also includes married women. For example, in 1950 married women ac- counted for less than 25% of the labor force; only 12% of women with pre- school children worked, and only 28% with school-age children worked. Now, however, 58% of married women are in the labor force, 60% with preschoolers work, and 75% with school-age children work. The problem, however, is that women continue to occupy the lower rungs of the occupa- tional ladder but are still responsible for most of the domestic responsibilities. The implications of these changes and facts are many.

� Common sense would indicate that women are subjected to a greater number of stressors than their male counterparts. This is due to issues related to family life and role strain. Studies continue to indicate that working women continue to carry more of the domestic burden, more responsibility for child care arrangements, and more responsibility for social and interpersonal activities outside of the home than married or partnered men (Morales & Sheafor, 2004).

� Family relationships and structures have progressively changed as we have moved from a traditional single-earner, two-parent family struc- ture to families with two wage earners. The increasing number of women in the workforce cannot be seen in isolation from the wider so- cial, political, and economic context (Farley, Smith & Boyle, 2003). For

Principles and Assumptions of Multicultural Social Work Practice 5

example, one quarter of the nation’s families are poor, one sixth have no health insurance, one in six small children live in a family where nei- ther parent has a job, women continue to be paid less than men, and 25% of children will be on welfare at some point before reaching adult- hood. Social workers must be cognizant of these changes and the impli- cations for their work.

� These disparities are systemic in nature. If social workers are concerned with social welfare, then it is imperative that meaningful policies and practices be enacted to deal with gender disparities.

The Changing Complexion of the Workforce and Society

People of color have reached a critical mass in the United States, and their numbers are expected to continue increasing (Lum, 2004). The rapid increase in racial/ethnic minorities in the United States has been referred to as the “diversification of the United States” or, literally, the “changing complexion of society.” From 1990 to 2000, the U.S. population increased 13% to over 281 million (U.S. Bureau of the Census, 2001). Most of the population increase consisted of visible racial/ethnic minority groups (VREGs): The Asian Amer- ican/Pacific Islander population increased by almost 50%, the Latino/His- panic population by over 58%, African Americans by 16%, and American Indians/Alaska Natives by 15.5%, in marked contrast to the 7.3% increase of Whites. Currently, people of color constitute over 30% of the U.S. popula- tion, approximately 45% of whom are in the public schools (D. W. Sue et al., 1998; U.S. Bureau of the Census, 2000). Projections indicate that persons of color will constitute a numerical majority sometime between 2030 and 2050 (D. W. Sue et al., 1998).

The rapid demographic shift stems from two major trends: immigration rates and differential birthrates. The current immigration rates (documented immigrants, undocumented immigrants, and refugees) are the largest in U.S. history. Unlike the earlier immigrants who were primarily White Europeans oriented toward assimilation, the current wave consists primarily of Asian (34%), Latin American (34%), and other VREGs who may not be readily as- similated (Atkinson et al., 1998; Sue & Sue, 2003). In addition, the birthrates of White Americans have continued to decline (Euro-American = 1.7 per mother) in comparison to other racial/ethnic minorities (e.g., African Ameri- can = 2.4, Mexican American = 2.9, Vietnamese = 3.4, Laotian = 4.6, Cambo- dian = 7.4, and Hmong = 11.9). Societal implications of the changing com- plexion are many:

� Approximately 75% of those now entering the labor force are visible racial/ethnic minorities and women. The changing complexion and feminization of the workforce have become a reality.

6 The Conceptual Dimensions of Multicultural Social Work Practice

� By the time the so-called baby boomers retire, the majority of people contributing to the Social Security and pension plans will be racial/eth- nic minorities. In other words, those planning to retire (primarily White workers) must depend on their coworkers of color. If racial/ethnic mi- norities continue to encounter the glass ceiling and to be the most under- educated, underemployed, underpaid, and unemployed, the economic security of retiring White workers looks grim.

� Businesses are aware that their workforces must be drawn increasingly from a diverse labor pool and that the current U.S. minority market- place equals the entire gross domestic product of Canada; projections are that it will become immense as the shift in demographics continues. The economic viability of businesses will depend on their ability to manage a diverse workforce effectively, allow for equal access and op- portunity, and appeal to consumers of color. On a much larger scope, however, a nation that deprives equal access and opportunity to these groups bodes poorly for our future viability.

� Students of color now constitute 45% of the population in our public schools. Some school systems, such as that in California, reached 50% students of color as early as the late 1980s. Thus, it appears that our ed- ucational institutions must wrestle with issues of multicultural educa- tion and the development of English as a Second Language (ESL).

� The diversity index of the United States stands at 49, indicating that there is approximately one chance in two that two people selected at random are racially or ethnically different.

These three pressing trends are only the tip of the iceberg in considering the importance of diversity (the elderly, women, and people of color) in social work practice. For the profession to respond adequately, it must also address issues of sexual orientation, ability/disability, religion, socioeconomic status, and so forth (Guadalupe & Lum, 2005).

Cultural Diversity and the Challenge to Social Work

How has the profession of social work done so far? If we assume that cultural encapsulation can be minimized through multicultural education and train- ing, then we can ask whether the profession is practicing what it preaches. In a review of cultural content coverage in three major social work journals (Families in Society—formerly Social Casework—Social Service Review, and Social Work) and 36 social work practice texts, one study revealed that (a) only 9% of articles in these journals addressed multicultural issues, (b) only 5% of the total pages of textbooks covered such topics, and (c) people of color were

Principles and Assumptions of Multicultural Social Work Practice 7

largely absent in publications over a more than 30-year history (Lum, 2004). Were we to conduct a similar study on other diverse groups like gays/lesbians, people with disabilities, religious groups, and so on, we would probably find similar results. The conclusion drawn is that social workers continue to be trained in traditional monocultural ways that do not enhance their cultural competence in dealing with diverse groups.

But what is culturally competent social work practice? How can we be- come adequately prepared to deal with the challenge? How can we make sure that we do not inappropriately impose our values and biases on our clients? How applicable are social work standards of practice for racial/ethnic minor- ity populations, gays/lesbians, women, and other culturally diverse groups? Is there any difference, for example, between working with White clients and working with Black clients? What do we mean by multiculturalism and di- versity? Do other diverse populations such as women, gays and lesbians, the elderly, and those with disabilities constitute a distinct cultural group? What do we mean by the phrase cultural competence?

Without an ability to answer and clarify these questions, social workers may be prone to misunderstandings and disagreements and may fail to un- derstand the sociopolitical implications of hot-button issues like racism, sex- ism, heterosexism, homophobia, and classism. Let us use an example to illustrate the emotional context of acknowledging and considering socio- demographic groupings.

Professor Jonathon Murphy felt annoyed at one of his Latina social work grad- uate students. Partway through a lecture on family systems theory, the student had interrupted him with a question. Dr. Murphy had just finished an analysis of a case study on a Latino family in which the 32-year-old daughter was still liv- ing at home and could not obtain her father’s approval for her upcoming mar- riage. The caseworker’s report suggested excessive dependency as well as “patho- logical enmeshment” on the part of the daughter. As more and more minority students entered the program and took Dr. Murphy’s classes on social work and family therapy, this sort of question began to be asked more frequently and usu- ally in a challenging manner.

STUDENT: Aren’t these theories culture-bound? It seems to me that strategies aimed at helping family members to individuate or become autonomous units would not be received favorably by many Latino families. I’ve been told that Asian Americans would also find great discomfort in the value orientation of the White social worker.

PROFESSOR: Of course we need to consider the race and cultural background of our clients and their families. But it’s clear that healthy development of family members must move toward the goal of maturity, and that means

8 The Conceptual Dimensions of Multicultural Social Work Practice

being able to make decisions on their own without being dependent or en- meshed in the family network.

STUDENT: But isn’t that a value judgment based on seeing a group’s value sys- tem as pathological? I’m just wondering whether the social worker might be culturally insensitive to the Latino family. She doesn’t appear culturally competent. To describe a Latino family member as “excessively dependent” fails to note the value placed on the importance of the family. The social worker seems to have hidden racial biases, as well as difficulty relating to cultural differences.

PROFESSOR: I think you need to be careful about calling someone incompetent and racist. You don’t need to be a member of a racial minority group to un- derstand the experience of discrimination. All human interactions are to some extent multicultural. What we need to realize is that race and eth- nicity are only one set of differences. For example, class, gender, and sexual orientation are all legitimate group markers.

STUDENT: I wasn’t calling the social worker a racist. I was reading a study that indicated the need for social workers to become culturally competent and move toward the development of culture-specific strategies in working with racial minorities. Being a White person, the social worker seems out of touch with the family’s experience of discrimination and prejudice. I was only trying to point out that racial issues appear more salient and prob- lematic in our society and that. . . .

PROFESSOR [INTERRUPTING AND RAISING HIS VOICE]: I want all of you [class members] to understand what I’m about to say.

First, our standards of practice and codes of ethics have been devel- oped over time to apply equally to all groups. Race is important, but our similarities far exceed differences. After all, there is only one race, the hu- man race!

Second, just because a group might value one way of doing things does not make it healthy or right. Culture does not always justify a prac- tice!

Third, I don’t care whether the family is red, black, brown, yellow, or even white: Good counseling is good counseling! Further, it’s important for us not to become myopic in our understanding of cultural differences. To deny the importance of other human dimensions such as sexual orien- tation, gender, disability, religious orientation, and so forth is not to see the whole person.

Finally, everyone has experienced bias, discrimination, and stereo- typing. You don’t have to be a racial minority to understand the detri- mental consequences of oppression. As an Irish descendant, I’ve heard many demeaning Irish jokes, and my ancestors certainly encountered se- vere discrimination when they first immigrated to this country. Part of our

Principles and Assumptions of Multicultural Social Work Practice 9

task, as social workers, is to help all our clients deal with their experiences of being different.

In one form or another, difficult dialogues such as the previous one are occurring throughout our training institutions, halls of ivy, governmental agencies, corporate boardrooms, neighborhoods, and community meeting places. Participants in such dialogues come with different perspectives and strong convictions and often operate from culturally conditioned assump- tions outside their levels of conscious awareness. These assumptions, how- ever, are important to clarify because they define different realities and de- termine our actions. As indicated earlier, insensitive social work practice can result in cultural oppression rather than liberation. Let us explore more thor- oughly the dialogue between professor and student to understand the im- portant multicultural themes being raised.

Theme One: Cultural Universality versus Cultural Relativism

One of the primary issues raised by the student and professor relates to the etic (culturally universal) versus emic (culturally specific) perspectives (Lum, 2003). The professor operates from the etic position. He believes, for ex- ample, that good clinical practice is good clinical practice; that disorders such as depression, schizophrenia, and sociopathic behaviors appear in all cul- tures and societies; that minimal modification in their diagnosis and treat- ment is required; and that Western concepts of normality and abnormality can be considered universal and equally applicable across cultures (Howard, 1992).

The student, however, operates from an emic position and challenges these assumptions. She tries to make the point that lifestyles, cultural values, and worldviews affect the expression and determination of deviant behavior. She argues that all theories of human development arise from a cultural con- text and that using the Euro-American value of “independence” as healthy development—especially on collectivistic cultures such as Latinos or Asian Americans—may constitute bias (Paniagua, 2001; D. Sue, Sue, & Sue, 2006).

This is one of the most important issues currently confronting the help- ing professions. If the assumption that the origin, process, and manifestation of disorders are similar across cultures were correct, then universal guidelines and strategies for treatment would appear to be appropriate in application to all groups. In the other camp, however, are multicultural specialists who give great weight to how culture and life experiences affect the expression of deviant behavior and who propose the use of culture-specific strategies in the helping professions (Atkinson, Morten, & Sue, 1998; T. L. Cross, Baz- ron, Dennis, & Isaacs, 1989; McGoldrick, Giordano, & Pearce, 1996; Parham, White, & Ajamu, 1999; D. W. Sue, 2001). Such professionals point out that

10 The Conceptual Dimensions of Multicultural Social Work Practice

current guidelines and standards of clinical practice are culture-bound and do not take into account issues of race, culture, gender, sexual orientation, and so forth.

Which view is correct? Should social work practice be based on cultural universality or cultural relativism? Few social workers today embrace the ex- tremes of either position, although most gravitate toward one or the other. Proponents of cultural universality focus on similarities and minimize cul- tural factors, whereas proponents of cultural relativism focus on cultural dif- ferences. Both views have validity. It is naive to believe that humans do not share universal characteristics. Likewise, if we talk about psychopathology, it is equally naive to believe that the relative frequencies and manners of symp- tom formation for various disorders do not reflect the dominant cultural val- ues and lifestyles of a society. Nor would it be beyond our scope to entertain the notion that various diverse groups may respond better to culture-specific intervention strategies. A more fruitful approach to these opposing views might be to address the following two questions: “What is universal in human behavior that is also relevant to social work practice?” and “What is the rela- tionship between cultural norms, values, and attitudes, on the one hand, and the manifestation of problematic situations and their treatments, on the other?”

Theme Two: The Emotional Consequences of “Race and/or Differences”

A tug-of-war appears to be occurring between the professor and the student concerning the importance of race and ethnicity in the therapeutic process. Disagreements of this type are usually related not only to differences in defi- nitions but also to hot buttons being pushed in the participants. The interac- tion between the professor and the student appears to be related more to the emotive qualities of the topic. What motivates the professor, for example, to make the unwarranted assumption that the Latina student was accusing the social worker of being a racist? What leads the professor, whether consciously or unconsciously, to minimize or avoid considering race as a powerful vari- able in the therapeutic process? He seemingly does this by two means: (a) di- luting the importance of race by using an abstract and universal statement (“There is only one race, the human race”) and (b) shifting the dialogue to discussions of other group differences (gender, sexual orientation, disability, and class) and equating race to one of these many variables.

It is not the author’s intent to negate the importance of other group dif- ferences in affecting human behavior or to deny the fact that groups share many commonalities regardless of race or gender. These are certainly legiti- mate points. The professor, however, appears uncomfortable with open dis- cussions of race because of the embedded or nested emotions that he has been

Principles and Assumptions of Multicultural Social Work Practice 11

culturally conditioned to hold. For example, discussions of race often evoke strong passions associated with racism, discrimination, prejudice, person blame, political correctness, anti-White attitudes, quotas, and many other emotion-arousing concepts. At times, the deep reactions that many people have about discussions on race interfere with their ability to communicate freely and honestly and to listen to others (D’Andrea & Daniels, 2001; Reynolds, 2001; Sue, 2003). Feelings of guilt, blame, anger, and defensive- ness (as in the case of the professor) are unpleasant. It is just so much easier to avoid dealing with such a hot potato. Yet it is precisely these emotionally laden feelings that must be expressed and explored before productive change will occur. Until social service providers work through these intense feelings, which are often associated with their own biases and preconceived notions, they will continue to be ineffective in working with a culturally diverse pop- ulation.

Theme Three: The Inclusive or Exclusive Nature of Multiculturalism

While the professor may be avoiding the topic of race by using other group differences to shift the dialogue, he raises a very legitimate content issue about the inclusiveness or exclusiveness of multicultural dialogues. Are defi- nitions of multiculturalism based only on race, or does multiculturalism en- compass gender, sexual orientation, disability, and other significant reference groups? Isn’t the professor correct in observing that almost all human inter- actions are multicultural? Those who resist including other groups in the multicultural dialogue do for several reasons: (a) Many racial minorities be- lieve that including other groups in the multicultural dialogue will enable people who are uncomfortable with confronting their own biases to avoid dealing with the hard issues related to race and racism; (b) taken to the ex- treme, saying that all human interactions are multicultural makes the con- cept meaningless because the ultimate extension equates all differences with individual differences; and (c) there are philosophical disagreements among professionals over whether gender and sexual orientation, for example, con- stitute distinct overall cultures.

It is undeniable that everyone is born into a cultural context of existing beliefs, values, rules, and practices. Individuals who share the same cultural matrix with us exhibit similar values and belief systems. The process of so- cialization is generally the function of the family and occurs through partici- pation in many cultural groups. Reference groups related to race, ethnicity, sexual orientation, gender, age, and socioeconomic status exert a powerful influence over us and influence our worldviews. Whether you are a man or a woman, Black or White, gay or straight, able-bodied or with a disability, married or single, and whether you live in Appalachia or New York all result

12 The Conceptual Dimensions of Multicultural Social Work Practice

in sharing similar experiences and characteristics. The definition of multicul- turalism must be inclusive.

Theme Four: The Sociopolitical Nature of Social Work Practice

The dialogue between professor and student illustrates nicely the symbolic meanings of power imbalance and power oppression. Undeniably, the rela- tionship between the professor and student is not an equal one. The profes- sor occupies a higher-status role and is clearly in a position of authority and control. He determines the content of the course, the textbooks to read, and the right or wrong answers on an exam, and he evaluates the learning progress of students. Not only is he in a position to define reality (standards of helping can be universally applied; normality is equated with individual- ism; and one form of discrimination is similar to another), but he can enforce it through grading students as well. As we usually accept the fact that educa- tors have knowledge, wisdom, and experience beyond that of their students, this differential power relationship does not evoke surprise or great concern, especially if we hold values and beliefs similar to those of our teachers. How- ever, what if the upbringing, beliefs, and assumptions of minority students render the curriculum less relevant to their experiential reality? More im- portant, what if the students’ worldviews are a more accurate reflection of re- ality than are those of the professors?

Many racial/ethnic minorities, gays and lesbians, and women have ac- cused those who hold power and influence of imposing their views of reality upon them. The professor, for example, equates maturity with autonomy and independence. The Latina student points out that among Hispanics collec- tivism and group identity may be more desirable than individualism. Unfor- tunately, Dr. Murphy fails to consider this a legitimate point and dismisses the observation by simply stating, “Culture does not always justify a practice.”

In social work, the standards used to judge normality and abnormality come from a predominantly Euro-American perspective (Anderson, 2003). As such, they are culture-bound and may be inappropriate in application to culturally diverse groups. Lum (2004) has noted that U.S. society has become progressively conservative and that social work reflects this change as well. When social workers unwittingly impose monocultural standards without regard for differences in race, culture, gender, and sexual orientation, they may be engaging in cultural oppression (NASW, 2001; Neville, Worthington, & Spanierman, 2001). As a result, social work practice may become a socio- political act. Indeed, a major thesis of this book is that traditional social ser- vice work has unwittingly done great harm to culturally diverse groups by invalidating their life experiences, by defining their cultural values or differences as deviant and pathological, by denying them culturally appro- priate care, and by imposing the values of a dominant culture upon them.

Principles and Assumptions of Multicultural Social Work Practice 13

Theme Five: The Nature of Culturally Competent Social Work Practice

The Latina student seems to question the social worker’s clinical or cultural competence in treating a Hispanic family. In light of the professor’s response to his student, one might question his cultural competence as a teacher as well. This may be an overly harsh statement because the professor probably has the best of intentions and is unaware of his own worldview. If clinical practice and education can be viewed as sociopolitical acts, and if we accept the fact that our theories of human behavior and treatment are culture- bound, then is it possible that social service providers trained in traditional Euro-American programs may be guilty of cultural oppression in working with their diverse clientele? The question social workers must ask is this: Is general social work competence the same as multicultural competence? Dr. Murphy seems to believe that “good clinical work” subsumes cultural com- petence, or that it is a subset of good clinical skills. The author’s contention, however, is that cultural competence is superordinate to general counseling competence. Let us briefly explore the rationale for this position.

While there are disagreements over the definition of cultural compe- tence, many of us know clinical incompetence when we see it; we recognize it by its horrendous outcomes, or by the human toll it takes on our minority clients. For example, for some time the mental health profession and pro- viders of services have been described in very unflattering terms by multicul- tural specialists: (a) They are insensitive to the needs of their culturally di- verse clients; do not accept, respect, and understand cultural differences; are arrogant and contemptuous; and have little understanding of their prejudices (Thomas & Sillen, 1972); (b) clients of color, women, and gays and lesbians frequently complain that they feel abused, intimidated, and harassed by non- minority personnel (Atkinson, Morten, et al., 1998; President’s Commission on Mental Health, 1978); (c) discriminatory practices in mental health deliv- ery systems are deeply embedded in the ways in which the services are or- ganized and in how they are delivered to minority populations, and are re- flected in biased diagnosis and treatment, in indicators of “dangerousness,” and in the type of personnel occupying decision-making roles (T. L. Cross et al., 1989); and (d) mental health professionals continue to be trained in pro- grams in which the issues of ethnicity, gender, and sexual orientation are ig- nored, regarded as deficiencies, portrayed in stereotypic ways, or included as an afterthought (Laird & Green, 1996; Meyers, Echemedia, & Trimble, 1991).

From this perspective, mental health professionals have seldom func- tioned in a culturally competent manner. Rather, they have functioned in a monoculturally competent manner with only a limited segment of the pop- ulation (White Euro-Americans), but even that is debatable. Many of the cur- rent social work theories and concepts derive mainly from a monocultural

14 The Conceptual Dimensions of Multicultural Social Work Practice

perspective. If we are honest with ourselves, we can only conclude that many of our standards of professional competence (Eurocentric) are derived pri- marily from the values, belief systems, cultural assumptions, and traditions of the larger society.

Thus, values of individualism and using “rational approaches” to prob- lem solve have much to do with how competence is defined. Yet many social service providers continue to hold firmly to the belief that good counseling is good counseling, thereby dismissing the centrality of culture in their defini- tions. The problem with traditional definitions of counseling, therapy, and so- cial service practice is that they arose from monocultural and ethnocentric norms that excluded other cultural groups. Social service providers must re- alize that what is perceived to be good social work practice often uses White Euro-American norms that exclude three quarters of the world’s population. Thus, it is clear that the more superordinate and inclusive concept is that of cultural competence.

The Multiple Dimensions of Human Existence

All too often, social workers seem to ignore, pay lip service to, or feel uncom- fortable acknowledging the group dimension of human existence (Guada- lupe & Lum, 2005). For example, a White school social worker who works with an African American family might intentionally or unintentionally avoid acknowledging the racial or cultural background of the family mem- bers by stating, “We are all the same under the skin” or “Apart from your racial background, we are all unique.” Reasons have already been given about why this happens, but such avoidance tends to negate an intimate aspect of the family’s group identity. As a result, the African American family might feel misunderstood and resentful toward the social worker, hindering the establishment of rapport.

First, much of social work practice, for example, is based on culture- bound values or beliefs that people are unique and that the psychosocial unit of operation is the individual; on the other side are values and beliefs that people are the same and that the goals and techniques of clinical practice are equally applicable across all groups. Taken to its extreme, this latter approach nearly assumes that persons of color, for example, are White and that race and culture are insignificant variables in the helping professions. Statements like “There is only one race, the human race” and “Apart from your racial/ cultural background, you are no different from me” are indicative of the ten- dency to avoid acknowledging how race, culture, and other group dimen- sions may influence identity, values, beliefs, behaviors, and the perception of reality (Carter, 1995; Helms, 1990; D. W. Sue, 2001).

Related to the negation of race is the problematic issue dealing with the

Principles and Assumptions of Multicultural Social Work Practice 15

inclusive or exclusive nature of multiculturalism. It has been suggested that an inclusive definition of multiculturalism (one that includes gender, ability/ disability, sexual orientation, etc.) can obscure the understanding and study of race as a powerful dimension of human existence (Carter, 1995; Carter & Qureshi, 1995; Helms, 1995; Helms & Richardson, 1997). This stance is not intended to minimize the importance of the many cultural dimensions of human identity but rather to emphasize the greater discomfort that many experience in dealing with issues of race rather than with other sociodemo- graphic differences (Carter, 1995). As a result, race becomes less salient and allows us to avoid addressing problems of racial prejudice, racial discrimina- tion, and systemic racial oppression. This concern appears to have great legit- imacy. When issues of race are discussed in the classroom, a social service agency, or some other public forum, it is not uncommon for participants to refocus the dialogue on differences related to gender, socioeconomic status, or religious orientation (à la Dr. Murphy).

On the other hand, many groups often rightly feel excluded from the multicultural debate and find themselves in opposition to one another. Thus, enhancing multicultural understanding and sensitivity means balancing our understanding of the sociopolitical forces that dilute the importance of race, on the one hand, and our need to acknowledge the existence of other group identities related to social class, gender, ability/disability, age, religious affili- ation, and sexual orientation, on the other (Anderson & Carter, 2003; D. W. Sue, Bingham, Porche-Burke, & Vasquez, 1999).

There is an old Asian saying that goes something like this: “All individ- uals, in many respects, are (a) like no other individuals, (b) like some indi- viduals, and (c) like all other individuals.” While this statement might sound confusing and contradictory, Asians believe these words to have great wis- dom and to be entirely true with respect to human development and identity. Some have found the tripartite framework shown in Figure 1.1 (D. W. Sue, 2001) to be useful in exploring and understanding the formation of personal identity. The three concentric circles illustrated in Figure 1.1 denote individ- ual, group, and universal levels of personal identity.

Individual level: “All individuals are, in some respects, like no other individu- als.” There is much truth in the saying that no two individuals are identical. We are all unique biologically, and recent breakthroughs in mapping the hu- man genome have provided some startling findings. Biologists, anthropolo- gists, and evolutionary psychologists had looked to the Human Genome Project as potentially providing answers to comparative and evolutionary biology, to find the secrets to life. Although the project has provided valuable answers to many questions, scientists have discovered even more complex questions. For example, they had expected to find 100,000 genes in the hu- man genome, but approximately 20,000 were found, with the possibility of another 5,000—only two or three times more than are found in a fruit fly or

16 The Conceptual Dimensions of Multicultural Social Work Practice

a nematode worm. Of those potential 25,000 genes, only 300 unique genes distinguish us from the mouse. In other words, human and mouse genomes are about 85% identical! While this discovery may be a blow to human dig- nity, the more important question is how so relatively few genes can account for our humanness.

Likewise, if so few genes can determine such great differences between species, what about within the species? Human inheritance almost guaran- tees differences because no two individuals ever share the same genetic en- dowment. Further, no two of us share the exact same experiences in our so- ciety. Even identical twins that theoretically share the same gene pool and are raised in the same family are exposed to both shared and nonshared experi- ences. Different experiences in school and with peers, as well as qualitative differences in how parents treat them, will contribute to individual unique- ness. Research indicates that psychological characteristics and behavior are affected more by experiences specific to a child than by shared experiences (Plomin, 1989; Rutter, 1991).

Group level: “All individuals are, in some respects, like some other individu- als.” As mentioned earlier, each of us is born into a cultural matrix of beliefs, values, rules, and social practices (D. W. Sue, Ivey, & Pedersen, 1996). By vir- tue of social, cultural, and political distinctions made in our society, perceived

Principles and Assumptions of Multicultural Social Work Practice 17

Figure 1.1 Tripartite Development of Personal Identity

Universal Level: Homo Sapiens

Group Level: Similarities and

Differences

A bi

lit y

to us

e sy

m bo

ls Com

m on

life experien

ce s

Self-awareness B iolo

gic al

an d

ph ys

ic al

si m

ila ri tie

s

Gender

Socioeconomic status

Age

Geographic location

Ethnicity

Disability/Ability

Culture

Religious preference

Marital status

Sexual orientation

Race

Individual Level:

Uniqueness

• Genetic endowment • Nonshared experiences

group membership exerts a powerful influence over how society views sociodemographic groups and over how its members view themselves and others (Atkinson, Marten, et al., 1998). Group markers such as race and gen- der are relatively stable and less subject to change. Some markers, such as education, socioeconomic status, marital status, and geographic location, are more fluid and changeable. While ethnicity is fairly stable, some argue that it can also be fluid. Likewise, debate and controversy surround the discussions about whether sexual orientation is determined at birth and whether we should be speaking of sexuality or sexualities. Nevertheless, membership in these groups may result in shared experiences and characteristics. They may serve as powerful reference groups in the formation of worldviews.

On the group level of identity, Figure 1.1 reveals that people may belong to more than one cultural group (e.g., an Asian American female with a dis- ability), that some group identities may be more salient than others (race over religious orientation), and that the salience of cultural group identity may shift from one to the other depending on the situation. For example, a gay man with a disability may find that his disability identity is more salient among the able-bodied but that his sexual orientation is more salient among those with disabilities.

Universal level: “All individuals are, in some respects, like all other individu- als.” Because we are members of the human race and belong to the species Homo sapiens, we share many similarities. Universal to our commonalities are (a) biological and physical similarities, (b) common life experiences (birth, death, love, sadness, etc.), (c) self-awareness, and (d) the ability to use sym- bols such as language. In Shakespeare’s Merchant of Venice, Shylock attempts to force others to acknowledge the universal nature of the human condition by asking, “When you prick us, do we not bleed?” Again, while the Human Genome Project indicates that a few genes may cause major differences be- tween and within species, it is startling how similar the genetic material within our chromosomes is and how much we share in common.

Individual and Universal Biases in Social Work

Unfortunately, clinical social workers have generally focused on either the in- dividual or the universal level of identity, placing less importance on the group level. There are several reasons for this orientation.

� First, our society arose from the concept of rugged individualism, and we have traditionally valued autonomy, independence, and unique- ness. Our culture assumes that individuals are the basic building blocks of our society. Sayings such as “be your own person,” “stand on your

18 The Conceptual Dimensions of Multicultural Social Work Practice

own two feet,” and “don’t depend on anyone but yourself” reflect this value.

� Second, the universal level is consistent with the tradition and history of the social sciences, which has historically sought universal facts, prin- ciples, and laws in explaining human behavior. Although an important quest, the nature of scientific inquiry has often meant studying phe- nomena independently of the context in which human behavior origi- nates. Thus, therapeutic interventions from which research findings are derived may lack external validity (S. Sue, 1999).

� Third, we have historically neglected the study of identity at the group level for sociopolitical and normative reasons. As we have seen, issues of race, gender, sexual orientation, and disability seem to touch hot but- tons in all of us because they bring to light issues of oppression and the unpleasantness of personal biases (Carter, 1995; Helms & Richardson, 1997; D. W. Sue et al., 1998).

If social work hopes to understand the human condition, it cannot ne- glect any level of identity. Explanations that acknowledge the importance of group influences such as gender, race, culture, sexual orientation, socioeco- nomic class, and religious affiliation lead to more accurate understanding of human behavior (Devore & Schlesinger, 1999). Failure to acknowledge these influences may skew research findings and lead to biased conclusions about human behavior that are culture-bound, class-bound, and gender-bound.

Thus, it is possible to conclude that all people possess individual, group, and universal levels of identity. A holistic approach to understanding per- sonal identity demands that we recognize all three levels: individual (unique- ness), group (shared cultural values and beliefs), and universal (common fea- tures of being human). Because of the historical scientific neglect of the group level of identity, this text focuses primarily on this category.

Before closing this portion of our discussion, however, a note of caution is added. While the concentric circles in Figure 1.1 might unintentionally sug- gest a clear boundary, each level of identity must be viewed as permeable and ever-changing in salience. In social work, for example, a client might view his or her uniqueness as important at one point in the session and stress com- monalities of the human condition at another. Even within the group level of identity, multiple forces may be operative. As mentioned earlier, the group level of identity reveals many reference groups, both fixed and nonfixed, that might impact our lives. Being an elderly, gay, Latino male, for example, rep- resents four potential reference groups operating on the person. The cultur- ally competent social worker must be willing and able to touch all dimensions of human existence without negating any of the others.

Principles and Assumptions of Multicultural Social Work Practice 19

What Is Multicultural Social Work Practice?

In light of the previous analysis, let us define multicultural social work prac- tice (MCSW) as it relates to the provision of social services and the roles of the social work practitioner:

Multicultural social work practice can be defined as both a helping role and a process that uses modalities and defines goals consistent with the life experiences and cultural values of clients; recognizes client identities to include individual, group, and universal dimensions; advocates the use of universal and culture- specific strategies and roles in the healing process; and balances the importance of individualism and collectivism in the assessment, diagnosis, treatment, and problem solving of client and client systems.

Let us extract more fully the implications of this definition for multicultural social work practice.

1. Helping role and process. MCSW involves acknowledging and broadening the roles that social workers play and expands the repertoire of prob- lem-solving skills considered helpful and appropriate. While many be- ginning students come to the field because of interest in the delivery of direct clinical services, the more passive and objective stance taken by clinical social workers is seen as only one method of helping. But unlike the clinical or counselor roles, MCSW practice encompasses activities like teaching, advising, consulting, and advocating on behalf of clients, which are central to effective social work practice. Thus, the roles of ed- ucator, advocate, case manager, organizer, facilitator of indigenous heal- ing systems, community broker, and so forth are considered vital to the practice of MCSW (NASW, 2001; D. W. Sue & Sue, 2003; Suppes & Wells, 2003).

2. Consistent with life experiences and cultural values. Effective MCSW practice means using modalities and defining goals for culturally diverse clients that are consistent with their racial, cultural, ethnic, gender, and sexual orientation backgrounds. Systems intervention, outreach programs, community advocacy, minimizing power differentials, and facilitating empowering social policies, for example, may be effectively used for some client populations (Devore & Schlesinger, 1999).

3. Individual, group, and universal dimensions of existence. As we have already seen, MCSW acknowledges that our existence and identity are com- posed of individual (uniqueness), group, and universal dimensions. Any form of helping that fails to recognize the totality of these dimensions negates important aspects of a person’s identity (D. W. Sue & Sue, 2003).

20 The Conceptual Dimensions of Multicultural Social Work Practice

4. Universal and culture-specific strategies. Related to the second point, MCSW believes that different racial/ethnic minority and other sociodemo- graphic groups might respond best to culture-specific strategies of help- ing. For example, research seems to support the belief that Asian Amer- icans are more responsive to directive/active approaches and that African Americans appreciate helpers who are authentic in their self- disclosures (Parham et al., 1999). Further, the Surgeon General’s report on Mental Health: Culture, Race, and Ethnicity makes it clear that thera- peutic approaches work differentially across ethnic groups and that “race matters” (U. S. Department of Health and Human Services, 2001). Likewise, it is clear that common features in helping relationships cut across cultures and societies as well.

5. Individualism and collectivism. MCSW broadens the perspective of the helping relationship by balancing the individualistic approach with a collectivistic reality that acknowledges our embeddedness in families, significant others, communities, and cultures. A client is perceived not just as an individual but as an individual who is a product of his or her social and cultural context. The ecological perspective is very important here. While the psychosocial unit is the individual in U.S. culture, many culturally diverse groups have a more collectivistic orientation that de- fines identity as a constellation that may include the family, group, or community (McGoldrick et al., 1996).

6. Client and client systems. MCSW assumes a dual focus in helping clients. In many cases, for example, it is important to focus on individual clients and encourage them to achieve insights and learn new functional and adaptive behaviors. However, when problems encountered by women, gays/lesbians, racial minorities, and the elderly reside in prejudice, dis- crimination, and in racism/sexism/ageism/heterosexism of employers, educators, and neighbors, or in organizational policies or practices in schools, mental health agencies, government, business, and society, the traditional therapeutic role appears ineffective and inappropriate. The focus for change must shift to altering client systems rather than indi- vidual clients alone (D. W. Sue & Sue, 2003; Vera & Speight, 2003). In- deed, while such a distinction may be made, social work has always de- fined clients as individuals, groups, families, communities, institutions, and larger social systems (Farley et al., 2003). In all cases, the guiding principle is one of social justice: equal access and opportunities for all groups. This is made abundantly clear in the Code of Ethics of the Na- tional Association of Social Workers when it states: “Social workers pro- mote social justice and social change with and on behalf of clients. ‘Clients’ is used inclusively to refer to individuals, families, groups, or- ganizations and communities” (NASW, 2001).

Principles and Assumptions of Multicultural Social Work Practice 21

2

C h a p t e r

23

“I know that differences are important, but I’m feeling overwhelmed. I don’t think it’s possible for anyone to become culturally competent. Look at all the groups in our society. They say I have to understand the perspectives of Blacks, Latinos, and Native Americans. They say I need to consider gen- der, sexual orientation, and socioeconomic status. Well, I ask, what about Islam, Christianity, people with disabilities? What about the elderly? What about people who live in different parts of the country? What about marital status? What about short people and fat people? Frankly, I don’t know where to begin. This is frustrating as all hell!” (personal journal of White trainee)

Such reactions as this one are very common among many studentsand professionals who are being challenged and asked to consider diversity factors in their practice. It is probably accurate to say that none of us can become fully knowledgeable about all the diverse groups in this nation and the world. Cultural competence must be seen as a life- long journey that never ends. Before we fully address this dilemma, however, let us begin the process of defining cultural competence and then return to the issue voiced by the person quoted.

Defining Cultural Competence in Social Work Practice

Principle 1.05, Cultural Competence and Social Diversity of the Code of Ethics (NASW, 1999), states the following:

(a) Social workers should understand culture and its function in hu- man behavior and society, recognizing the strengths that exist in all cultures.

(b) Social workers should have a knowledge base of their clients’ cul- tures and be able to demonstrate competence in the provision of ser-

Becoming Culturally Competent in Social Work Practice

vices that are sensitive to clients’ cultures and to differences among people and cultural groups.

(c) Social workers should obtain education about and seek to understand the nature of social diversity and oppression with respect to race, ethnicity, na- tional origin, color, sex, sexual orientation, age, marital status, political be- lief, religion and mental or physical disability.

As a result of these values, the NASW published a major document on standards related to cultural competence for social work practice (NASW, 2001), which defined cultural competence as referring “to the process by which individuals and systems respond respectfully and effectively to people of all cultures, languages, classes, races, ethnic backgrounds, religions, and other diversity factors in a manner that recognizes, affirms, and values the worth of individuals, families and communities and protects and preserves the dignity of each.” The publication outlined ten standards that set parameters for the development of cultural competence in social work practice. Among these were self-awareness, cross-cultural knowledge, cross-cultural skills, and em- powerment and advocacy.

Along with the profession of psychology (APA, 2003), the NASW was among the first to take such a strong stand about the importance of cultural competence. While the document is an important first step in the develop- ment of cultural competency standards, the inspirational and aspirational lan- guage provided in these documents will possess little value unless it can be op- erationalized and placed into actual practice. In my attempt to give meaning and life to the definition of cultural competence, I will rely heavily upon the work of the NASW, the American Counseling Association, and the American Psychological Association (2003; NASW, 1999, 2001; D. W. Sue et al., 1982; D. W. Sue, Arredondo, & McDavis, 1992; D. W. Sue et al., 1998). In many cases, the standards and guidelines overlap significantly with one another.

The Four Components of Cultural Competence

Consistent with the earlier definition of multicultural social work practice, it becomes clear that a culturally competent social worker is working toward several primary goals. First, a culturally competent social worker is one who is actively in the process of becoming aware of his or her own assumptions about human behavior, values, biases, preconceived notions, and personal limitations (Lum, 2003, 2005). Second, a culturally competent social worker is one who actively attempts to understand the worldview of his or her cul- turally different client. In other words, what are the client’s biases, values, as- sumptions about human behavior, and so on? Third, a culturally competent social worker is one who is in the process of actively developing and practic-

24 The Conceptual Dimensions of Multicultural Social Work Practice

ing appropriate, relevant, and sensitive intervention strategies and skills in working with his or her culturally different client. Fourth, a culturally com- petent social worker understands how organizational and institutional forces may enhance or negate the development of cultural competence. These four goals make it clear that cultural competence is an active, developmental, and ongoing process and that it is aspirational rather than achieved. Let us more carefully explore these attributes of cultural competence.

Competency One: Becoming Aware of One’s Own Assumptions, Values, and Biases about Human Behavior

As a social worker, what stereotypes, perceptions, and beliefs do you person- ally and professionally hold about culturally diverse groups that may hinder your ability to form a helpful and effective relationship? What are the world- views you bring to the interpersonal encounter, and how do you define prob- lem solving? What value systems are inherent in your professional theory of helping, community work, educating, administrating, and what values under- lie the strategies and techniques used in these situations? Without an aware- ness and understanding of your worldview, you may inadvertently assume that all groups share it. When this happens, you may become guilty of cul- tural oppression, inadvertently imposing your definitions of reality, right and wrong, good and bad, or normal and abnormal on your culturally diverse cli- ents.

In almost all human service programs, social workers, counselors, and therapists are familiar with the phrase “Counselor, know thyself.” Training programs stress the importance of not allowing your biases, values, or hang- ups to interfere with the ability to work with clients and client systems. In most cases, such a warning stays primarily on an intellectual level, and very little training is directed at having trainees get in touch with their own values and biases about human behavior (Brammer, 2004; Fong, 2001). In other words, it appears to be easier to deal with trainees’ cognitive understanding about their own cultural heritage, the values they hold about human behav- ior, their standards for judging normality and abnormality, and the culture- bound goals toward which they strive than the disturbing affective and em- bedded assumptions that may oppress others.

What makes examination of the self difficult is the emotional impact of attitudes, beliefs, and feelings associated with cultural differences that may result in unintentional racism, sexism, heterosexism, able-body-ism, and ageism. For example, as a member of a White Euro-American group, what re- sponsibility do you hold for the racist, oppressive, and discriminating manner in which you personally and professionally deal with persons of color? This is a threatening question for many White people. Likewise, how have men benefited from male privilege and the oppression of women, whether know-

Becoming Culturally Competent in Social Work Practice 25

ingly or unknowingly? To be culturally competent means that one has adequately dealt with these questions and worked through the biases, feel- ings, fears, and guilt associated with them. Future chapters will return to this matter.

Competency Two: Understanding the Worldview of Culturally Diverse Clients

How do race, gender, and sexual orientation influence worldviews? Do women see the world differently than men? Do gays/lesbians see the world differently than straights? Is there such a thing as an African American, Asian American, Latino(Latina)/Hispanic American, or American Indian world- view? While there are many commonalities shared by all groups, research strongly supports the contention that worldviews are strongly shaped by group membership. It has become increasingly clear that many minority per- sons hold worldviews that differ from those of members of the dominant cul- ture. Chapters 5 and 6 examine one specific aspect of worldviews—racial/ cultural identity for both racial/ethnic minorities and Whites. One can define a worldview (DuBray & Sanders, 2003; D. W. Sue, 1978) as how a person per- ceives his or her relationship to the world (nature, institutions, other people, etc.). Worldviews are highly correlated with a person’s cultural upbringing and life experiences (Ibrahim, 1985; Katz, 1985; Trevino, 1996). Ivey, Ivey, and Simek-Morgan (1997) refer to worldviews as “the way you frame the world and what it means to you,” “one’s conceptual framework,” or “how you think the world works.” Ibrahim (1985) refers to worldviews as “our phi- losophy of life” or “our experience within social, cultural, environmental, philosophical, and psychological dimensions.” Put in a much more practical way, not only are worldviews composed of our attitudes, values, opinions, and concepts, but also they may affect how we think, define events, make de- cisions, and behave.

It is crucial that social workers understand and be able to share the worldview of their culturally diverse clients (Slattery, 2004). This statement does not mean that providers must hold these worldviews as their own, but rather that they should see and accept other worldviews in a nonjudgmental manner. Some have referred to the process as cultural role taking: The White social service provider, for example, acknowledges that he or she has not lived a lifetime as a sexual minority, racial minority, or member of another culturally diverse group. It is almost impossible for the culturally different pro- vider to think, feel, and react as a racial minority, for example. Nonetheless, cognitive empathy, as distinct from affective empathy, may be possible. In cultural role taking the social worker acquires practical knowledge concern- ing the scope and nature of the client’s cultural background, daily living ex- perience, hopes, fears, and aspirations. Inherent in cognitive empathy is the

26 The Conceptual Dimensions of Multicultural Social Work Practice

understanding of how social services relate to the wider sociopolitical system with which minorities contend every day of their lives.

Competency Three: Developing Appropriate Intervention Strategies and Techniques

Social work and social workers must begin the process of developing appro- priate and effective helping, teaching, communication, and intervention strategies in working with culturally diverse groups and individuals. This competency means prevention as well as remediation approaches, and sys- tems intervention as well as traditional one-to-one relationships. Addition- ally, it is important that the social worker have the ability to make use of in- digenous helping/healing approaches and structures that may already exist in the minority community (Yeh, Hunter, Madan-Bahel, Chiang & Arora, 2004). The concept here is to build on the strengths of a community and to empower them in their ability to help themselves (Anderson, 2003; West- brooks & Starks, 2001).

Effectiveness in helping clients is most likely enhanced when the social worker uses intervention modalities and defines goals that are consistent with the life experiences and cultural values of clients (Asian American Fed- eration of New York, 2003). This basic premise will be emphasized through- out future chapters. Studies have consistently revealed that (a) economically and educationally marginalized clients may not be oriented toward “talk therapy”; (b) self-disclosure may be incompatible with the cultural values of Asian Americans, Hispanic Americans, and American Indians; (c) the socio- political atmosphere may dictate against self-disclosure from racial minori- ties and gays and lesbians; (d) the ambiguous nature of traditional casework approaches may be antagonistic to life values of certain diverse groups; and (e) many minority clients prefer an active/directive approach to an inactive/ nondirective one in treatment. Social work must not assume that clients share a similar background and cultural heritage and that the same ap- proaches are equally effective with all clients.

Because groups and individuals differ from one another, the blind ap- plication of techniques and strategies to all situations and all populations seems ludicrous. The interpersonal transactions between the social worker and client require differential approaches that are consistent with the per- son’s life experiences (D. W. Sue et al., 1996). In this particular case, and as mentioned earlier, it is ironic that equal treatment in clinical work, for ex- ample, may be discriminatory treatment! Clinical social workers need to un- derstand this important point. As a means to prove discriminatory mental health practices, racial/ethnic minority groups have in the past pointed to studies revealing that minority clients are given less preferential forms of treatment (medication, electroconvulsive therapy, etc.). Somewhere, confu-

Becoming Culturally Competent in Social Work Practice 27

sion has occurred, and it came to be believed that to be treated differently is akin to discrimination. The confusion centered on the distinction between equal access or opportunities and equal treatment. Marginalized and op- pressed groups may not be asking for equal treatment so much as they are asking for equal access and opportunities. This dictates a differential approach that is truly nondiscriminatory.

Competency Four: Understanding Organizational and Institutional Forces that Enhance or Negate Cultural Competence

It does little good for social workers to be culturally competent when the very organization that employs them is filled with monocultural policies and prac- tices. In many cases, organizational customs do not value or allow the use of cultural knowledge or skills. Some social service organizations may even ac- tively discourage, negate, or punish multicultural expressions. Or client prob- lems may be the result of institutions that oppress them. Thus, it is impera- tive to view cultural competence for organizations as well. The question to ask is “What constitutes a culturally competent system of care?” If our soci- ety truly is to value diversity and to become multicultural, then our organi- zations (mental health care delivery systems, businesses, industries, schools, universities, governmental agencies, and even professional organizations like the NASW) must move toward becoming multicultural. Developing new rules, regulations, policies, practices, and structures within organizations that enhance multiculturalism is important.

Social workers must understand how institutional forces may enhance or negate cultural competence. In some ways, they must become increasingly skilled as organizational change agents and understand multicultural organi- zational development (Browne & Mills, 2001; see Chapter 11). Elsewhere, I have described some basic tenents of multicultural organizational develop- ment. It (a) takes a social justice perspective (ending of oppression and dis- crimination in organizations); (b) believes that inequities that arise within organizations may not be primarily due to poor communication, lack of knowledge, poor management, person-organization fit problems, and so on but to monopolies of power; and (c) assumes that conflict is inevitable and not necessarily unhealthy (D. W. Sue & Sue, 2003).

Multicultural organizational work is based on the premise that organi- zations vary in their awareness of how racial, cultural, ethnic, sexual orien- tation, and gender issues impact their clients or workers. Institutions that rec- ognize and value diversity in a pluralistic society will be in a better position to avoid many of the misunderstandings and conflicts characteristic of mono- cultural organizations. They will also be in a better position to offer culturally relevant services to their multicultural populations and allow mental health

28 The Conceptual Dimensions of Multicultural Social Work Practice

professionals to engage in organizationally sanctioned roles and activities without the threat of punishment. Moving from a monocultural to a multi- cultural organization requires the counselor or change agent to understand their characteristics. Ascertaining what the organizational culture is like, what policies or practices either facilitate or impede cultural diversity, and how to implement change is crucial.

A Working Definition of Cultural Competence

Thus, to be an effective multicultural helper requires cultural competence. In light of the previous analysis, we define this quality in the following manner:

Cultural competence is the ability to engage in actions or create conditions that maximize the optimal development of client and client systems. Culturally com- petent social work practice is defined as the service provider’s acquisition of awareness, knowledge, and skills needed to function effectively in a pluralistic democratic society (ability to communicate, interact, negotiate, and intervene on behalf of clients from diverse backgrounds), and on an organizational/societal level, advocating effectively to develop new theories, practices, policies, and orga- nizational structures that are more responsive to all groups.

First, this definition of cultural competence in the helping professions makes it clear that the conventional one-to-one, in-the-office, objective form of treatment aimed at remediation of existing problems may be at odds with the sociopolitical and cultural experiences of their clients. Like the comple- mentary definition of MCSW, it addresses not only clients (individuals, fam- ilies, and groups) but also client systems (institutions, communities, policies, and practices that may be unhealthy or problematic for healthy develop- ment). This is especially true if problems reside outside rather than inside the client. For example, prejudice and discrimination such as racism, sexism, and homophobia may impede healthy functioning of individuals and groups in our society.

Second, cultural competence can be seen as residing in three major do- mains: (a) the attitudes/beliefs component—an understanding of one’s own cultural conditioning that affects the personal beliefs, values, and attitudes of a culturally diverse population; (b) the knowledge component—understand- ing and knowledge of the worldviews of culturally diverse individuals and groups; and (c) the skills component—an ability to determine and use cultur- ally appropriate intervention strategies when working with different groups in our society.

Third, in a broad sense, the definition is directed toward two levels of cultural competence: the level of the person/individual and the level of the

Becoming Culturally Competent in Social Work Practice 29

organization/system. The work on cultural competence has generally focused on the micro level, the individual. In the education and training of clinical social workers, for example, the goals have been to increase the level of self-awareness of trainees (potential biases, values, and assumptions about human behavior); to acquire knowledge of the history, culture, and life experiences of various minority groups; and to aid in developing culturally appropriate and

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