Identifying Cultural Issues Including Bias in the Counseling Room

Valerie Proctor Greene, Licensed Psychotherapist and Life Coach at Thriveworks Chesapeake, leads an online workshop titled “Identifying Cultural Issues Including Bias in the Counseling Room.” Below, you’ll find information about Greene, followed by highlights from her presentation:

About Valerie Proctor Greene, Licensed Psychotherapist and Life Coach:

Greene is passionate about personal growth through self-reflection, mental health and wellness in marginalized populations, treating trauma, and advocacy for women and children. Here are some highlights from her career:

25+ years in clinical practice
9 years teaching Multicultural Clinical Practice at Simmons University MSW program
Experience with PTSD, Domestic Violence, and Sexual Assault
Consulted on numerous cases where trauma was overlooked and the symptoms/presenting problems were the sole focus of assessment and diagnosis
Treatment began and therapeutic alliance was built. At this point, trauma came out or was missed altogether due to clinician’s perspective of the client’s narrative.

Workshop Goals

Gain a clear understanding of the terms “Ethnicity,” “Race,” and “Culture,” both their definitions and distinctions
Explore the role culture plays in our own lives; how it shapes our worldview and functioning
Make the connection between culture and presenting problems in how counselors assess their clients
Learn how to avoid premature diagnosis and assessment without exploring cultural context through the client’s narratives
Expand on the trauma informed approach to treatment to better incorporate cultural systemic barriers

Definitions: Ethnicity, Race, Culture

Ethnicity: ancestry, specifically country of origin. Individuals usually possess several ethnicities, but may choose to identify with some more than others.
Race: a social construct based upon physical appearance and characteristics; becoming increasingly complex as more people are descendants of multiple ethnicities.
Culture: shared values, beliefs, worldview, and shared experiences such as language, religion, child rearing practices, gender roles, customs/rituals, shared history, and coping styles

Understanding Client Culture: Dig a Little Deeper

The identifying information
Family history, religion, values, gender roles, childrearing
Community/environmental strength and challenges
What, if any, vulnerable populations would the client belong to? (class, race, gender, sexual orientation, religion should be explored)
This is their narrative—where we listen for trauma

Trauma and Cultural Context

Here at Thriveworks, when we meet our client for the intake visit, our assessment includes asking if they have a trauma history. Many times the client will say no or they are not sure.
After we develop a therapeutic alliance and gain trust, more of the narrative comes out in sessions
How often can we say that we discover that there is a trauma history and the client comes from a background where it has been normalized? Too often this is due to cultural context or our own biases which are based upon what we may unconsciously normalize as well.
Examples may be verbal or physical abuse, abandonment, community or war violence, extreme poverty, multiple losses to violence, or extreme bullying.

Misdiagnosing or Overlooking Trauma

When we ignore cultural context we run the risk of prematurely pathologizing or misdiagnosing our clients
Assessment and Diagnosis based solely on symptoms, negates environmental circumstances and/or systemic oppression which is likely a part of the sociocultural narrative and trauma of our clients
The importance of naming trauma: When we hear trauma in our clients’ narratives, it is critical to name it as such. This validates that you see them as a person undeserving of the trauma. It negates victim blaming and acknowledges social injustices.

Approaches to Treatment: Trauma Informed Therapy and Social Justice Informed Therapy

In therapy, the Trauma Informed Approach includes and recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; responds by fully integrating knowledge about trauma into policies, procedures, and practices; and seeks to actively resist re-traumatization.

“While Trauma Informed Therapy is important, Social Justice Informed Therapy is even more important. One cannot fully practice Trauma Informed Therapy without understanding the trauma of social injustice.” –Maria Peredes, PhD

Keep the following in mind to use the Trauma and Social Justice Informed Approach:

Remember what the term “culture” means
Explore and become aware of your own culture and be open to facing your own biases
Ask and listen for cultural context in the client’s narrative
This should be done through the multilayered conceptualization
As you hear trauma being normalized in the client’s history, name it as such
Validate the experience as one that was not deserved and not the client’s fault
Make sure they feel emotionally and physically safe
Monitor and contain acute symptoms before any intensive exploratory work to avoid re-traumatizing
When the client is not having acute symptoms and feels safe, begin the Trauma and Social Justice Informed Approach
This includes validating the trauma as well as the systems of historical and present forms of oppression our clients often endure