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Dissertation.

An exploration and critical analysis of the role of therapeutic counselling within a multi-cultural society.

1. Introduction

This assignment has been undertaken as a result of the

author’s growing awareness of the challenges faced by

counsellors working in an increasingly multicultural

society. The propensity of some researchers and theorists

to dogmatise or formulise specific theoretical approaches as

being most relevant and efficacious to client outcome,

coupled with accompanying changes in training and the

ongoing need to engage in professional development may have

had subtle or more obvious impacts on the role and delivery

of multicultural counselling over the past several decades.

It is the intent of this assignment to explore and

critically analyse the role of counselling within a multi-

cultural society. It will examine the possible challenges

to and limitations of counselling within a socio-culturally

diversified society. The study will address the subject of

counselling within the multi-cultural society, its

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relevance, and effectiveness across the trans-cultural

populace. The study will also seek to explore the identity

formations on multicultural levels and examine potential

tensions within the therapeutic relationship. It is further

the intent to assess and evaluate the impact of research

within the subject area on to current practice.

2. Methodology

It should be borne in mind that there has been comparatively

little British research carried out in the area of multi-

cultural counselling. Therefore, a large percentage of the

theoretical evidences used in this essay are American, and

other, in origin. In defining what research was available,

various search engines and academic literary resources were

accessed. A considerable number of referenced works are

older (i.e. more than ten years since first publication).

At least one work is a seminal text from 1962 (i.e. Wrenn).

It is felt such materials are relevant to charting and

evaluating the history and progression of multi-cultural

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counselling. Both quantitative and qualitative research

resources were explored. The quantitative research model is

based on provable statistical data and analyses. The aim is

to identify the relationship between independent and

dependent variables. The quantitative approach does not

allow for complex processes but formulates an image of the

investigative base, recording those factors associated with

change. Quintana et al believe quantitative research to be a

vital component in the advance of multiculturalism. Whilst

it may be equated with traditional, Eurocentric scientific

models and be seen, by some, to have either stigmatised or

ignored minority groups within society, the approach may be

positively used to create awareness of such stigmatisation.

The structured nature of quantitative methodology can help

in the realisation of specific goals that identify cultural

processes, clarify multicultural theories, and inform socio-

political practices.

The more naturalistic and arguably less obtrusive

qualitative approach aims to understand the views of

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individuals without making judgements based on the

researcher’s own values and beliefs. Meaning is given to

individual world constructs and perceptions. It is an

approach that tends to be used more widely in ethnographic

studies. Morrow (2007) argues that counselling psychology

has been in the forefront of qualitative enquiry in

dissertation research. However, Morrow acknowledges that

the move towards global acceptance of the qualitative method

remains limited. Nevertheless, it can be suggested that

such methodology is both relevant and credible given the

paradigms that are characteristic of the multicultural

variables. It is, however, beyond the compass of this

assignment to adequately explore in depth the paradigms that

underpin qualitative research methodology. The field of

multiculturalism is large, encompassing such variables as

race, culture, ethnicity and religion. In order to keep

within manageable research boundaries, the assignment aims

at taking an overall view of the role of therapeutic

counselling within multicultural society rather than

focusing on one particular aspect of multiculturalism.

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Search engines used include SpringerLink; Google Scholar;

LinkSource; Taylor and Francis; PsycArticles; EBSCOhost;

ProQuest; PsychINFO, MEDLINE, Academic Search Premier,

Education Research Complete, Business Source Premier, Wiley

Online. Terms used included multi-cultural+ counselling + therapeutic

relationship + transcultural + Eurocentric + Britain + ethical practice.

Abstracts were read to ascertain relevancy of texts to this

assignment.

3. Literature Review

Although there has been a massive surge in both the practice

and use of counselling skills within Britain over the last

fifty years those skills have evolved within a monocultural

framework and through the application of such theoretical

approaches as psychodynamic, humanistic and cognitive

behavioural models. MacLeod (1993) promulgated that

counselling has served the dominant culture within society

whilst largely ignoring the needs of minority groups who are

often disadvantaged against. In concurrence with MacLeod’s

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stance, Moodley (1999) argues that whilst counselling in a

multicultural context has increased, the main area of

criticism in relation to counselling is that it has remained

predominantly Eurocentric and individualistic in its

approach. Benish et al (2011) postulate that whilst

psychotherapy and counselling, as historically developed and

practised, is suitable for dominant cultural groups in

Western Europe and North America it may not be appropriate

for those groups that consist of ethnic and racial

minorities. Indeed, Puskar & Marquis-Kerner (2007) propose

that research into the availability and effects of therapy

for minority populations is limited in terms of its nature

and scope. Salvendy (1999) declares that what information

is available comes from researchers and therapists who

belong to particular racial or ethnic groups.

One of the earliest proponents for cultural diversity, Wrenn

(1962), warned of the effect of cultural encapsulation and called

for greater diversity in the practise and delivery of

treatments. In 1991, Ibrahim noted that diverse approaches

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to multicultural assessment, practice, and training had been

developed following and during the previous two decades.

Whilst these gave rise to recommendations for clarification

of world view constructs, there remains no specific

construct in place. The worldview itself acts as the

mediating variable within counselling practice.

Bernal et al (2009) posit psychotherapy [counselling]

interventions be modified in line with the values, beliefs

and worldviews of the clients. The concepts of culture are

diverse and complex. Such complexities have important

implications for counselling. The very nature of the

counselling process calls for sensitivity towards how the

client experiences and expresses their inner and outer

world. This may be particularly relevant in a multicultural

setting where the non-dominant culture of the client may be

at odds to those values and beliefs held by the dominant

culture.

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Netto (2006) adduces that good multicultural practice is

dependent on culturally sensitive counselling for all.

However, Chantler (2005) questions the notion of cultural

sensitivity in a therapeutic context, arguing it suggests

cultures are fixed and non-evolving. Racial identity has

been identified by Kwan (2001) as being an interactive

variable that intercedes in the counselling relationship,

hence supporting Chantler’s argument.

Over the last two decades there has been an increasing

influx of people into Britain from the European Union,

Eastern European States (as a result of the opening up of

the Soviet Bloc countries), and immigrants from Hong Kong,

and South East Asia. These, in addition to those settlers

in Britain from the old Commonwealth nations, Asians, Afro-

Caribbeans and Africans, who immigrated to Britain in the

years following the Second World War, now make up the

kaleidoscope of what is modern multicultural Britain. All

have brought with them their hopes and dreams, skills and

expectations, fears and uncertainties. Each has their roots

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firmly planted within their own cultural norms. They have

their own socio-cultural beliefs, customs, rites, and

rituals. Family structures are often different, with

differing values and beliefs from those of the mainstream

culture. . Laungani (2005) identifies that, in some

cultures, there still exists a socio-political tendency to

believe migrants need to wholly abide by the norms of that

culture in order to speed up the assimilation into

mainstream society in order for multiculturalism to work.

Sam (2006) reflects that it is common practice for dominant

cultures to be concerned about the influx of non-dominant

cultures into the main populace. Unlike Brox (cited in

Lithman, 2004: 164), who purports the need for immigrants to

discard their own cultural values and traditions in favour

of assimilating those of the new society, Sam reflects that

people are deeply rooted in their culture, with such values

extending over several generations. Palmer & Laungani

(1999) argue there is the danger that the host country,

through forced assimilation, implies an assumption that the

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host culture is superior to the cultures of immigrant

populations.

Nelson-Jones (2002) intimates there is a possibility of the

therapist focusing on the individual and neglecting to take

into consideration the impacts of family and community

values. He argues that multi-cultural counselling is both

more complex and varied than is often perceived, with

insufficient research into theory and practice. There is

little regard given to those anthropological concepts that

define culture. There is confusion between what is implied

by ethnicity, faith, and culture. Lilley (2008:2) points

out that whilst Sikhs and Jews have combined ethnic and

religious identities, this is not the case in other areas

but does not prevent misconceptions: “…being Muslim is often

now used as a description of race and ethnicity. A Muslim

police officer is so described, whereas a Christian police

officer would not be described in this way”. Confusion about

terminology is rife in all areas of our society but the

counsellor working multiculturally must be clear what

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factors constitute race, culture, ethnicity, and religion.

An ongoing challenge to counsellors working within any area

is the avoidance of stereotyping clients. Just as a

counsellor working with clients who have AIDS needs to be

aware that not all the clients have contracted the syndrome

through drug use or promiscuity, so does the counsellor who

is working across cultures has to be aware that all Muslims

do not originate from Middle Eastern countries. That whilst

a client may originate from Iran or India, it does not

necessarily follow that such a client will be Muslim or

Hindu. Race does not always decree religion or religion

decree culture or ethnicity. Laungani (2005) proposes that

multiculturalism defies a precise definition as it

encompasses and encapsulates a diverse spectrum of shades of

values, meanings, attitudes and values. Glockshuber (2005)

observes that the phenomenon of globalisation is creating

rapidly changing cultural diversity. As a result, it is

important that the interactions between culture and such

diversity are understood in terms of the perceptions and

ways of processing specific to the individual. The need for

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conceptualisation of cultural adaptations within the

therapeutic bailiwick has been categorised by Sue et al

(2009) into three areas that incorporate the qualities or

identity of therapists, the counselling process and, the

content of the treatment. Fourali (2009) remonstrates that

regardless of how much humans have achieved in terms of

technological and scientific advances, there remains

elusiveness to their ability to resolve psychological and

social conflicts.

Patterson (1996) had recognised the difficulties involved

in attempts to recommend specific counselling approaches to

fit ethnic minority groups. He adduces that all counselling

is multicultural due to the generic nature of counselling.

Therefore, he argues, multiculturalism is moving towards a

universal system of counselling. Johannes & Erwin (2004)

debate that there are always degrees of etic influence

within the therapeutic process. They also highlight the

potential problems inherent in over-emphasising ethno-

cultural differences, hence offering the assumption that

only a counsellor of a similar cultural background to a

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client can work effectively within that therapeutic

relationship.

Challenges to the multicultural nature of society are

intrinsic to the therapeutic relationship. Lago (2006)

submits the view that both counsellors and clients are

participants in whatever the prevailing socio-cultural

climate may be. The attitudes, forces and assumptions that

make up that climate will affect the lives of all

participants. To over-simplify the nature of society and

counselling within such may result in anti-therapeutic

practice. There is a need for therapists to be aware of

their own attitudes, assumptions, and beliefs. Kareem, in

1978, (cited in Lago) identified that the fact of being from

a different culture invokes conscious and unconscious

assumptions on the parts of both counsellor and client

alike. He suggests that such assumptions needed to be

addressed from the beginning of therapy. Murphy (1986) also

highlights the awareness of differences and their potential

impact on therapeutic outcomes. He recommends that all

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workers in the mental health arena should receive training

in how their own cultural perceptions may impinge on the

issues brought by clients.

Moodley (2004) postulates theories of personality and social

behaviours are culture specific, with the recognition of the

blinkered perceptions and worldviews of such specifics

contributing to the development of multicultural

counselling. Eleftheriadou (2003) puts forth the premiss

that the increasing amount of research and available

literature relating to cross cultural studies, evidences

past misdiagnoses. Whilst such misdiagnoses are more

applicable to psychiatric and/or clinical psychological

assessments, there may be some overlap into the counselling

arena where assumptions about another’s values, norms and

practices are made.

Aluede & Maliki (2005) refer to culture being not an aspect

of counselling but, rather, being central to all

counselling. They argue that all counselling is, to some

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extent, multi-cultural due to the infinite number of

possible counsellor/client combinations and it is important

for the counsellor to understand what is suitable to

specific clients from different environments. Sue (1992)

expostulates that counselling stands at the crossroads of

monoculturalism and multiculturalism. The path of the

former is the basis of the traditional counselling theories,

hence it holds to the White, Eurocentric, definitions of

values, beliefs and practices. The latter path, although

being less travelled, recognises and embraces diversity,

pluralism, and integration; challenging the counsellor to

use culturally appropriate strategies. Nelson-Jones points

out the importance of demographic statistics in establishing

the extent of multiculturalism, an area that in British

literature and research tends to be largely ignored.

D’Ardenne (1993) appears some nine years previously, to

offer a similar observation adducing a growing awareness of

the need to provide a greater range of services for a

multicultural society; the nature of racial demographics in

UK being somewhat different from multiracial/multicultural

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demographology in USA and Europe. Over fifty per cent of

Black people in Britain are British-born rather than

nationalised citizens. Littlewood (1992) suggests the

neglect of minority groups within the talking therapies as

clients, counsellors, psychotherapists, supervisors,

researchers, and trainers, is a British phenomenon. Britain

tends not to see itself as a country of immigrants, unlike

USA and Europe, resulting in the possibility that

therapeutic practitioners may not feel the necessity of

making race, culture and ethnicity factors in working with

mental health issues. Fernando (2010) however, emphasises

that UK society is now underpinned by traditions and

cultures from both Asia and Africa; cultural traditions that

are now evident within the dominant, White culture in the

forms of food and music.

Willett (1998) asserts that multiculturalism lacks a

unifying theory partially due to the limited way it has been

understood. Moodley (2007) suggests the ideology of

multiculturalism in counselling and psychotherapy is too

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narrowly defined. Whilst it can be said to have undergone

radical development since its inception in the 1960’s,

multicultural counselling and psychotherapy has fixed

culture and race as independent and objective variables.

Therefore, it may be said to have failed to have wider

significance to all client groups. The fixed set of

multicultural competencies is offered to all clients

regardless of their ethnic, cultural or other stigmatised

identities. This is further borne out by Vontress and

Jackson (2004) who posit the development of multicultural

counselling competencies are hampered by restricting the

focus to the four minority groups in the USA (i.e. Native

American; African American; Asian American; Latin American)

to the exclusion of disability, class and sexual

orientation. The hegemonic practice of Eurocentric

therapeutic approaches to working cross-culturally may be

said to remain. Wrenn (cited in Pederson, 2007:7) warned

that staying rigidly within a specific therapeutic model

might encourage cultural encapsulation. This is the process

of working with clients ethnocentrically, where the

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counsellor does not understand the worldview and culture of

origin of the client or integrates that knowledge into the

counselling process. Swanger (1999) posits that

monoculturalism constrains individuality and diversity; that

within the new paradigm of multiculturalism, such rigidity

resembles the monocultural model thus constricting diversity

within new boundaries. Liggan & Kay (2006) purport that

race and racism are part of contemporary society and they

will be present in the therapeutic relationship as long as

they remain part of the socio-cultural marginalisation

process of minority communities within a hegemonic society.

Arredondo (1994) argues multicultural counselling fails to

include white participants within the multicultural

spectrum. Moodley (2007) concurs, hypothesizing that this

has resulted in the creation of the illusion of a single

white identity that paradoxically constructs such an

identity whilst ignoring the diversity of Western

ethnicities and cultures. In their article focusing on the

social construction of race in USA, Pope-Davis & Liu (1998)

adduce the concept of what defines race in the counselling

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arena continued to be discussed with little consensus on

what it means and how it might potentially impact on the

counselling process. Feltham (2008) reviews psychosomatic

themes and body oriented aspects of psychotherapy, exploring

somatic vulnerability and multiculturalism. He proposes

that it is the task of the therapist to understand and work

with the differences that are encountered within the

therapeutic relationship, with attention being paid to those

conventional aspects of therapeutic interaction (i.e. body

language, symbolism, transference). However, Feltham (2007)

also describes both parties in the therapeutic relationship

as being damaged human beings in a damaging civilisation

experiencing, at best, moments of therapeutic wholeness

within the relationship when cultural equivocalities are

temporarily reconciled.

Hansen (2010) explores the intraindividual diversity of

multiculturalism and argues the appreciation of diversity

has long been a main theme in counselling history. However,

the ways to advance the value and development of such

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diversity within the therapeutic bailiwick remains divided.

Hansen (2010a) compares modernism and postmodernism in the

arena of multicultural diversity and contends there remains

a void in where counsellors recognize and conceptualise such

diversity. However, he suggests postmodernism as a theory

of intraindividual diversity that could be an important tool

in moving multicultural counselling forward.

In 1985, Bales argued that the emphasis should be on making

services more meaningful to those groups in society who are

most disadvantaged. Ibrahim (1991) identified the need for

the focus of multicultural counselling to be on how it can

be more effective and available for those individuals or

groups who are considered to be different in terms of race,

culture or gender. However, this transposes

multiculturalism, keeping it bound mainly to race, culture

and gender. It fails to encompass other areas of diversity

such as age, disability, social class, etcetera, all of

which can be perceived as cultural differentiations.

Moodley (2007) argues that the hypothesis of

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multiculturalism is untenable if restricted to ethnic or

racial groups. In order to be psychologically effective, it

needs to encompass diversity and difference in a far wider

sense. Multiculturalism needs to embrace the widest gamut of

human experience and individuality. The question then

arises as to how this perceived need may best be met in the

best interests of the counsellor, the client and the greater

society.

Reviewing a diverse range of articles, journals and literary

texts led to a more in-depth exploration of the subject area

that incorporates critical analysis of relevant criteria

relating to the role, effectiveness and changing face of

multicultural counselling.

4. Discussion

Ethical Practice: Competencies, Training, and Approaches

Roach (1999) argues that just as a culture-free state does

not exist; neither does a culture-free counsellor. With

that being a paramount factor, respect should be shown to

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all clients, the counsellor recognising, appreciating and

embracing differences. The British Association for

Counselling and Psychotherapy (2010) refers to the ethical

principle of Justice. This is defined as the provision of a

fair and impartial treatment of all clients which

encompasses not only those legal and ethical obligations to

the client but also a commitment to fairness requiring the

counsellor to appreciate differences between people and

avoid discriminatory practices. Ethical practice could be

argued, therefore, to need a multicultural orientation

requiring counselling to move beyond present theories and

being ready to embrace an increasing awareness of

multicultural issues within the therapeutic relationship.

Sue et al (1992) challenged the counselling profession to

address the issue of multicultural counselling competency,

identifying a need to recognise that counselling reflects

the values of the large society in which in functions. They

called for a change to the philosophical premiss of

counselling that would include movement towards a more

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inclusive, altruistic and judicial model. Arrendondo et al

(1996) recommended a set of multicultural counselling

competencies be adopted (operationalised) for use as

standard practice in USA. The competencies, created for

multicultural practice by the Association for Multicultural

Counseling and Development (AMCD), compart guidelines for

counsellors to follow. Supporters of the competencies press

for their adoption by the American Counseling Association

(ACA). However, the initial competencies would appear to

emphasise the importance of race within the counselling

bailiwick whilst divorcing race from the, arguably, far

wider implications of diversity. Weinrach & Thomas (2002)

contend the very competencies designed to combat racism

effectively ignore other minority groups by actively

distinguishing between ‘multicultural’ and ‘diversity’. If

this were the case, the competencies may be tentatively said

to be grounded in multiracial rather than multicultural

practice. Nevertheless, the competencies do advocate that

multicultural counsellors should, in addition to working

towards eliminating discrimination and prejudices, work

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towards developing sensitivity to issues of elitism, sexism,

heterosexism, and oppression. Although there is, as

previously noted, relative paucity in British research

relating to multicultural counselling, Sloman (2005)

suggests a move away from the earlier cultural deficit

models of psychological theories towards more culturally

different models. Such changes, she proposes, have begun to

both influence and inform counselling practice. However, it

can be argued that the emphasis of the paper again being on

racial differences promotes the more traditional racial,

ethnic, cultural biases whilst negating the importance of

other diversities both internal and external to the

previously identified traditional triadic base.

Patterson (2004) argues against the need for multicultural

counselling competencies, submitting that the competencies

are lacking in the very philosophical foundations that Sue

et al (1992) identified as being necessary. The competencies

would appear to simply be a compilation of the basic

counselling tenets of the knowledge and skills to comprehend

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the worldview and values of the client. However, the

critique itself may be said to be demonstrating a paradox as

Patterson acknowledges some counsellors would “need special

preparation [italics added] to work with clients from

particular groups.” (p.67) and recommends an immersion of

the counsellor, as an aspect of training, into the socio-

cultural community of the client. Other than such

internship however, Patterson does not offer any guidance as

to what else may constitute “special preparation” other than

citing Rogers (1957) five basic counsellor qualities. In

itself, this may also be argued to be a contradiction to the

idea of internship within the culture of the client being

necessary. There may also be the question of whether such

cultural specific training would be as relevant if diversity

rather than ethno-cultural factors were to be included.

Nevertheless, Patterson may be seen to reflect the findings

of Tomlinson-Clarke & Ota-Wang (1999) who suggested

multicultural counselling training may be more effective

when experiential in nature.

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Abreu et al (2000) explore future directions of multicultural

counsellor training and competencies. They identify the

importance of extending such training into the area of

supervision but also observe the paucity of studies

evidencing the effects of racial and ethnic differences in

supervision on trainee counsellors. It may be debated that

as supervision is the mainstay in monitoring, developing,

supporting and challenging client-work throughout a

counselling career, the importance of the potential impact

of multiculturalism within this relationship, which is often

didactic or instructive, would appear to be vital. It is

interesting to note that of those research studies carried

out (e.g. Ledany et al, 1997); it would appear there are

higher ratings of trainee competency when the supervisor was

of a different ethnic or racial background from the

supervisee.

The relevancy and importance of the nature of training would

seem to be paramount in most areas of multicultural

counselling. Most research tends to focus on the racial and

ethnic components of what multiculturalism is. However,

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findings from such research studies, and subsequent methods

of working, may be argued to be applicable across the wider

gamut of group diversity. The importance of encouraging and

embedding awareness of multi-cultural and diversity issues

within counselling training is becoming more apparent. In

the three decades since the need for such awareness moved

into the general counselling arena, the nature of training

has undergone continuing change. D’andrea et al (1991)

examined the impact of multicultural counselling training on

trainee counsellor development. At that time multicultural

training approaches included the single course, which

offered an effective and resource cost effective way to

enhance knowledge of working multiculturally, and an

infusion approach to training. The infusion method offered

various multi-cultural competency experiences across the

curriculum. This approach was more demanding of resource

allocations that counsellor training programmes had

available at that time and so was less popular. The

framework developed by D’Andrea et al was based around three

main objectives: promoting trainee self-awareness; promoting

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knowledge; promoting skill development through role-playing

situations with diverse cultures. When compared to control

groups, the outcomes of those participants in the training

were significantly improved hence evidencing the

effectiveness of training.

In relation to counselling models employed, Ivey et al (1997)

posit that any approach would only be relevant and

beneficial if employed in a culturally meaningful and

sensitive manner. Carl Rogers believed his theory (client-or

person-centred) was more suited to multicultural counselling

because its emphasis is on non-evaluative judgements by the

counsellor and has its focus in the therapeutic relationship

rather than specific techniques or strategies. Rogers

(cited by MacDougall, 2002) referred to the importance of

white counsellors trying to understand and accept any anger

directed at their whiteness and that the counsellors listen

to their own feelings and speak out about them. It is

interesting that Parker & Schwartz (2002) present a similar

argument in relation to white counsellors. They promulgate

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the process of developing multicultural counselling

competency involves the trainee counsellors experiencing a

diverse spectrum of emotions. The emotions of shame and/or

guilt tend to increase as the white trainee counsellor’s

self-awareness develops. There is then the possibility of

this impacting onto the therapeutic relationship and

potentially lead to defensive responses; prevent true

empathic understanding, interrupting the counselling process

and preventing effective multicultural competency. Parker &

Schwartz, like Rogers, recognise the vital importance of

developing and monitoring trainee self-awareness and the

need to work through any feelings that arise related to

multicultural issues. Rogers believed that as those

cultural differences were expressed that the persons behind

the cultures would be discovered. There was recognition in

Rogers theory that the “constructive choices were products

of their time and cultural setting” (cited by MacDougall,

2002:50).

Ridley et al (1994), put forward a ‘Perceptual Schema Model’

analysing and evaluating the aspect of cultural sensitivity

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in multicultural counselling. This model of cultural

sensitivity is defined as being a distinct perceptual

process. In contrast to Rogers’ person centred approach that

warns against reliance on nomothetic information (cited in

MacDougall, 2002:62), Meehl (cited in Ridley et al, 1994:127)

identifies a need for a “…nomological network…testable laws

constituting a theory”. As Ridley et al stress, however, the

measuring of success of culturally sensitive counselling

and/or its limitations within the multicultural arena is

extremely difficult. There have been some attempts at

measurements of counselling competency, cited by Ridley et

al, i.e. Cross-Cultural Competence Inventory (CCCI;

Hernandez & LaFromboise, 1985) and Cross-Cultural Competence

Inventory - Revised (CCCI-R; LaFromboise, Coleman &

Hernandez, 1991). A main theme of the arguments of Ridley

et al is that cultural sensitivity often appears to be

confused with multicultural or cross-cultural competencies

which are suggestive of a cluster of various, yet different,

constructs. Ridley et al give voice to a belief in and

commitment to multicultural counselling incorporating both

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cultural data and cultural sensitivity into the counselling

process. As each individual is a product of their culture,

counsellors need to be able to tap into their client’s

experiences as individual cultural beings.

In order for counselling to be multiculturally effective and

relevant in promoting change, there seems to be consensus of

the importance of some level of training in working cross-

culturally. Parker & Schwartz support the three specific

domains identified by D’Andrea et al (1991) and Arredondo et al

(1996) which underpin the multicultural counselling

competencies developed via AMCD. Strous (2006) also

espouses the postmodernist perspective of the need for

reflexivity in counselling, encouraging the critical

reflection on, and evaluation of, interventions and

practices used by counsellors. Hansen (2010a), as noted

earlier, saw postmodernist theory as a potentially effective

tool in the development of multicultural counselling. The

gap in which counsellors may fail to recognise and

conceptualise the enormity of diversity in all its forms may

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be narrowed by the opportunity for both trainees and

qualified therapists to undertake some aspects of

multicultural training coupled with increased learning in

self-awareness. There remains, nevertheless, a challenge to

the effectiveness of multicultural counselling that is

rooted in ideologically encapsulated positions adopted by

some counsellors and theorists. Strous cites Pederson’s

Triad Training Model, which basically comprises of a role-

play scenario between counsellor, client, and anti-

counsellor. The anti-counsellor acts as an observer of the

practice but, in this model, gives immediate feedback on

what may impede therapeutic rapport. A pro-counsellor may

also be used in the role-play to intervene with positive

messages to the client. Strous extended this training model

in the form of anti-client and pro-client roles. Again, in

the article by Strous, the white counsellor ‘shame/guilt’ is

mentioned. However, the use of anti-client/pro-client

interplay indicated an increased awareness of such things as

own racist tendencies, awareness of a tendency to

overcompensate when working multiculturally, and an

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increased engagement in interracial counselling with less

intellectualisation. The question arises whether the

Anticlient-Proclient Model as proposed by Strous could act

as a specific tool to close the void identified by Hansen or

whether there are other factors involved in the development

of multicultural competency. Minami (2009) also explores

the area of multicultural counselling competency, exploring

the aspect of counsellor attitude. Minami believes attitude

may be another pertinent, and additional, factor in the

efficacy of multicultural counselling. Attitude is assumed

to be additional to the other components that currently make

up the tri-componential model and that have been the focus

of the majority of multicultural counselling research and

training for the past thirty years. Minami looks for the

role a counsellor’s attitude plays in the therapeutic

relationship. The original components, devised by Sue et al

(1982), of multicultural competencies were: belief/attitude;

knowledge; skills. These competencies were later revised

and became: awareness; knowledge; skills. The ‘attitude’

component was removed. Minami offers the attitude factor as

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an essential fourth component. There is no clear definition

of what attitude is, although Minami offers that it may be

described as “a complex psychological construct containing

multidimensional characteristics and processes” (p.40). The

reference to attitude being a construct is analogous to the

arguments of Ibrahim (1991), previously mentioned, positing

the worldview is the mediating variable in any counselling

practice. It could be debated that this idea can be applied

to a far wider populace than race, culture, and ethnicity.

To acknowledge the existence of individual worldview

constructs also acknowledges the diversities and variables

within any given socio-cultural construct. It may be

argued, therefore, that the acceptance of diversification

being the norm rather than the exception allows for a

greater self-awareness and hence a wider spectrum of the

self-knowledge of attitudinal aspects on the part of the

counsellor. Therefore, it could be debated whether the re-

admission of attitude to the tri-componential model as a

fourth component would be either necessary or effective in

promoting change in the multicultural counselling arena.

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Nonetheless, Minami’s Four Componential Model may be seen as

augmenting the Tri-Componential Model rather than replacing

it. The attitude component may serve to highlight and

encourage the exploration of differing constructs, allowing

counsellors to develop an energetic, constructive attitude

that could allow for growth, a deeper acceptance of

diversity, and improved competency in practice. Unlike

awareness, the second component, attitude is not only the

acknowledgement of the counsellor’s self-awareness, their

own biases, values, etcetera, and the impact of those on the

therapeutic relationship. Attitude would seem to embrace

the cultural diversity of the client more fully, allowing

the counsellor to be more engaged in the constructs

(worldview) of the client. Whilst arguing the importance of

attitude as an external, additional factor Minami identifies

the construct of attitude as consisting of cognitive and

behavioural processes that dispose the individual to emit

certain affective, cognitive or behavioural responses. It

may be proposed that such an argument is based on the

cognitive behavioural approach that has at its roots the

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individual’s assumptions for living, their inferences and

evaluations, which subsequently impact on their affective,

cognitive and behavioural responses. Hays (1995) argued

that a strength of the cognitive behavioural approach is the

eclecticism of the available tools and techniques that can

be employed to taper the therapy to the needs of the

individual. It may be said to work with the constructs of

the client, allowing integration of assessment throughout

the therapy and emphasising progress from the perspective of

the client. However, as Hays also asserts, the theorists

and originators of the model are from European or American,

middle-class, university educated backgrounds. Therefore,

it may be questionable whether this model can be said to be

value neutral although the flexibility of the model has

increased over the past decade and now includes techniques

such as Mindfulness which is an adaptation of Buddhist

practice.

Counsellor/Client match

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Whether there is more evidence of successful outcomes if

counsellor/client match is closer has also been the

foundation of various research projects. Tharp (1991) was

amongst one of the first to formulate the theory that

treatments are more successful if there is compatibility

between the culture patterns of counsellor and client. A

study carried out by Whitfield et al (2010) investigated the

effects of client/counsellor match on successful vocational

rehabilitation. Their conclusion did not support other

findings for racial/ethnic mismatch. On the contrary, the

study suggested there were no significant differences

between racial/ethnic match and positive outcomes.

Interestingly, Whitfield et al posit this may be linked to

the counsellors being both more experienced and better

trained. The study took place in USA. The State of Texas

where it was carried out requires any [rehabilitation]

counsellors to be trained to national or state-approved

standards. A further significant fact from the study

relates to clients also having disabilities (in the form of

alcohol or drug misuse) which would suggest an even greater

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diversity of match/mismatch factors being present other than

racial and/or ethnic parameters. A recent study by Meyer,

Zane and Cho (2011) points to the theory of social

categorisation where the individual forms judgements based

on the evidence available at the time. This argument finds

support in such research projects as that of Ward (2005) who

adduces the race of the counsellor is the first thing the

client notices at the initial meeting. There are

comparative pieces of research, empirical studies by Flicker

et al (2008) and others, that link racial match to better

therapy outcome with fewer premature drop-outs.

Nonetheless, as in the study by Whitfield et al and others

(for example, Gamst et al, 2004) there would seem to be little

or no correlation between racial match and treatment

outcomes.

Karlsson (2005) undertook a review of three types of studies

relating to the effect of ethnic matching between therapist

and patient [client]. The work may be seen as an overview.

The outcomes are diverse and contradictory. Analogue

studies indicate there is sometimes a preference for an

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ethnic match although when a client is given a wider choice,

that preference becomes secondary to other factors such as

experience of the therapist. Archival studies tend to

evidence ethnic match as important to therapeutic outcome.

However, clients are able to self-select and such selection

may be affected by the levels of acculturation of the client

etcetera. The third research method, psychotherapy process

and outcome, suggests that ethnic matching has no impact on

therapeutic process.

In addition to the ongoing contentions of racial/ethnic

matching in therapeutic relationships, including the

possible initial prejudices of the client, there is the

further matter of stereotyping of clients by counsellors and

how this may impact on their clinical judgements. As the

client makes judgements about the therapist in the first

meeting, so the counsellor may make assumptions about the

client both prior to and at initial meeting. Rosenthal

(2004) believes such assumptions are made based on

stereotypical perceived characteristics. Stereotyping is

often the result of limited information, and access to more

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information may lessen the impact on the relationship. The

threat of stereotyping a client, therefore, is stronger

during the early phases of the relationship when a

counsellor’s knowledge of the client is most limited. This

danger to the alliance has been researched and documented

over several decades (e.g. Eddy, 1990) as has the ongoing

repercussions of stereotyping. Initial impressions are

resistant to change and current research (e.g. Horvarth et

al, 2011) underpins seminal texts (e.g. Sandifer et al, 1970)

that indicate early impressions may lead to unsuccessful,

ineffective counselling. The perceptions of the counsellor

when based on stereotypical judgements may adversely affect

both the therapeutic relationship and the outcome of therapy

for the client. Preconceived models of client cultural

backgrounds (i.e. race/ethnic features) may influence client

work in terms of what the therapist may deem as suitable

interventions. Studies (e.g. Strohmer and Leierer, 2000)

indicate that stereotypical preconceptions of therapists

also extend to those other diverse areas of gender,

sexuality, disability, social class, and age. Counsellor

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preconceptions are not limited to race and ethnicity.

Therefore, overall research findings on ethnic and/or other

matching may be said to be unreliable and contradictory.

Therapeutic Relationship

The therapeutic relationship is probably one of the most

researched factors in the field of counselling and

psychotherapy. Patterson (1996) argued the immanent nature

of the relationship should be the same regardless of client

group and the competent counsellor is one who can provide an

effective therapeutic relationship. The respect and

genuineness displayed by the counsellor should be

facilitative of the essential requirements of the client’s

self-disclosures, while the ability to convey empathy

through entering the world of the client may be the crucial

factor in effective therapeutic outcomes (Ibrahim, 1991).

Ergo, whether the nature of the counselling relationship can

be the same across cultures may be dependent upon the

counsellor’s ability to grasp and offer what the full

meaning of empathy might be to the individual.

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The need to establish a strong therapeutic relationship

across cultural divides is vital to successful outcome

(Asnaani & Hofmann, 2012). The importance of a good,

working therapeutic alliance has been identified by all the

major counselling approaches. This relationship is equally

as important when working multiculturally but may be said to

carry multifarious challenges for both practitioner and

client. It may be argued that here is one of the major

challenges to working empathically. The traditional western

ethics that govern counselling practice may be oppugned when

working cross-culturally. Whilst the ethical and

professional codes of practice may fit with western

individualistic society, they are less likely to be valid

when applied to other cultures. Certain taboos, as

identified by Sue (2001), could act to prevent the

development of an effective and relevant therapeutic

relationship. Ethical frameworks include: no advice giving

as this may encourage dependency on the part of the client;

no self-disclosure of thoughts or feelings on the part of

the therapist as this is unprofessional; the counsellor

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should not engage in bartering with the client as this may

alter the nature of the relationship; dual relationships

should be avoided as they may result in the counsellor’s

loss of objectivity; receiving of gifts by the therapist may

result in feelings of obligation to the client. In

considering these guides for ethical and professional

practice in a multicultural setting, it becomes obvious how

constrained the counsellor may be. Many cultures welcome

advice and suggestion giving as part of a helping

relationship, where it would aid empowerment. The lack of

self-disclosure by the counsellor may be interpreted as

coldness and insincerity by the client if the sharing of

feelings and thoughts are seen, in the culture of the

client, as valuable in the helping relationship. In many

societies, bartering is an acceptable way of conducting

business transactions, as is the giving of gifts to

demonstrate respect and gratitude. Additionally, the non-

dualistic western therapeutic approach may detract from the

development of a successful client/counsellor relationship

where the client belongs to a culture or tradition where

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multiple-role relationships are the norm (i.e. where a

healer performs other functions like counselling, spiritual

guidance, advice giving, etcetera).

With such division between the western approach to

counselling practice and the diverse needs and challenges of

working cross-culturally, there may be concern in

determining how that divide can be crossed. Asnaani &

Hofman suggest a person-specific assessment to ascertain how

much of the client’s problem may be linked to cultural

identity. This, together with therapist self-education and

training in multicultural competency would allow a more in-

depth knowledge of the client’s culture specific issues. An

exploration of the client’s expectations of the therapeutic

relationship and what the client’s perceptions are of

attending counselling would benefit the building of an

effective alliance. The client’s expectation of successful

outcome would appear to be commensurate with the early

forming of the therapeutic relationship (Constantino et al,

2005). It may also be the client identifies with

hierarchical cultures and expects a directive approach by

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the therapist, whilst the more collaborative approach of

western models may act to alienate the client. For example,

the Indian client is more likely to be drawn towards a

therapist that appears as an expert, one who can be

respected and deferred to. This is further borne out by

Moodley (1999) in a given example of his own experience with

an Indian client. The vignette explores the challenges to

the counselling process and Moodley’s own struggles as a

therapist. It also clearly demonstrates the cultural

differences between English and Hindu worldviews. The

client’s use of archetypal imagery, metaphors, and symbols

reflected his cultural inheritance. His eventual use of a

traditional Hindu healer (a Vaid) and his departure from the

Western counselling therapy demonstrates that there are

client needs outside the usual parameters of the counselling

relationship.

Traditional healing practices, social justice and

counselling

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There has been resurgence in the west over the last twenty

to thirty years of traditional healing modalities. More

people are accessing complementary therapies at the same

time as attending counselling. There appears to be a

developing need to look outside the parameters of the

western model of psychotherapy and this may be interpreted

as a failure in how multicultural therapy is practiced

(Moodley & West, 2005). The move towards multiculturalism

encompassing the diversities of gender, sexual orientation,

social class and disability may be seen to lack drive,

paying lip-service to intellectual and theoretical

developments whilst ignoring the real needs of training and

research in an increasingly diverse society. Other aspects

of cultural diversity may appear to continue to be largely

ignored; religion and spirituality tend to be overlooked as

another expression of diversity (Yarhouse & Fisher, 2002)

even though many people from different cultures invoke

religious and spiritual deities or powers as part of the

healing process and at times of stress. Therapists often

encounter clients from diverse religious backgrounds,

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spiritual beliefs and faiths; clients may present with

issues relating to their spiritual beliefs. Harborne (2008)

suggests more training should be available in working with

spiritual care, more awareness encouraged through research,

journals and conferences, a greater availability of

resources and specialist services. Feltham (2008)

differentiates between spirituality and religion, seeing

spirituality as a state of striving towards greater

awareness through such media as meditation, breathing

exercises, and yogic practice. Such practices are being

more widely introduced into the therapeutic relationship,

allowing greater flexibility of approach that may be more

suited to a multicultural society. The adaptation of

Mindfulness into the cognitive behavioural approach may be

seen as a partial evidencing of one cause of somatic

disturbances being linked to suppressed emotional issues

(Leader & Corfield, 2007), often in the forms of addictions

or eating disorders.

The influx of cultures into the West have brought

traditional health care and healing with alternative

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therapies and there is an increasing number in western

society who seek traditional non-western healing, often to

complement counselling therapy. From the author’s own

experience there also appears to be a growing number of

counsellors becoming interested and training in aspects of

non-western healing traditions such as Reiki, Chi Gung, and

Reflexology.

The growth of multicultural awareness and the infinity of

its spectrum may be argued to act as a celebration of

diversity. However, it may also be said to have uncovered

awareness of social injustices and inequality of service

provision in addition to the contentious rigidity of

dominant worldviews. In the growing global social and

economic crises, therapists are becoming cognisant of the

changing needs of society. Vera & Speight (2003) called for

counsellors and mental health professionals to be ready to

commit to working for social justice and to expand

professional roles beyond the boundary of one-to-one

counselling. Although competences and ethical frameworks

exhort counsellors to be aware of injustice and oppression,

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there are few specifics given on how to confront such

exploitations other than counsellors own self-awareness of

ethical practice. One aspect of western psychotherapy

tradition is the importance placed on the autonomy of the

individual in recognising and employing their own resources.

Notwithstanding, in a meritocratic society such as Britain,

USA, and western European countries, the acquisition and

application of resources will not be equitable in a society

where marginalisation of some groups is a source of socio-

political power. Martin-Baro (1994) contended that

psychology [psychotherapy] should strive to change the

world, not simply seek to understand it. From this view

point there is fracture between an ethical emphasis of

justice and the stress placed on the autonomy of the

individual. The counsellor may be in a better position to

help the client identify and activate sources of potential

support, thus adjusting the counselling role to suit the

needs of the client.

5. Conclusion and recommendations.

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Gaps in research and training do exist, particularly in

Britain. There are organisations in Britain that offer

counselling to ethnic minority specific groups, for example

Mapesbury Clinic in London who offers counselling to adult

refugees and asylum seekers, and there are also independent

counsellors, like Kal Badesha, who work to promote

multicultural counselling within their community.

Nonetheless, further research and training are required.

Training to work with diverse cultures should play a greater

part in the curriculum that it currently does, and such

training should encompass more than the trainee’s own

awareness of labels, prejudices, and etcetera. It should

look beyond the boxes of traditional western approaches, and

be prepared to offer what is needed.

There would appear to be both awareness and recognition of

adaptation of counselling practice to benefit the wider,

multicultural and diverse client populaces. Another

proponent for such practice and mentioned in the earlier

literature review, Fourali (2009), argues that given the

complexities of psychological phenomena there is always

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potential for the development or introduction of diverse

psychological tools into therapy sessions. Such

potentiality allows for the flexible adoption of models that

reflect the worldview of the client. This flexibility may

be particularly relevant to those clients who may not engage

with the Western, Eurocentric models. As things stand, the

current models of psychotherapy may be argued to be another

agency of social control but better, and more relevant,

training for students, therapists and supervisors alike may

go a long way to changing this. Continuing developments in

counsellor training for working in multicultural and diverse

areas would now appear to be looking towards a bigger

picture. Challenges to the current system of therapy, like

those of Morrall (2009) cannot be ignored. From such

arguments and research, there may develop a freedom to move

away from the rigidity of any specific therapeutic

approaches; a growing pluralism in both societal and

therapeutic relationships, with more emphasis on social

justice and advocacy particularly in working with racial,

ethnic or other disadvantaged minority groups. Whilst the

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threat of encapsulation is always present in any such

developments, either in terms of theoretical approaches or

cultural sensitivity models (for example Chantler, 2005),

the awareness of the threat may enable more universal, less

restrictive, socio-multicultural models to develop.

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[word count: 8,095 inc. subheadings]

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