Clients Perceptions of Multicultural Counseling Competence: Current Status and Future Directions

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1 Clients Perceptions of Multicultural Counseling Competence: Current Status and Future Directions Madonna G. Constantine Mai Kindaichi Tina J. Arorash Peter C. Donnelly Kyung-Sil K. Jung Teachers College, Columbia University This article presents a reaction to Pope-Davis et al. s major contribution concerning the importance of obtaining clients perceptions of counselors multicultural competence. Implications of their research findings for counseling psychology training, practice, and research are discussed. Multicultural counseling competence has been defined as counselors attitudes/beliefs, knowledge, and skills in working with culturally diverse clients (Sue, Arredondo, & McDavis, 1992). This tripartite conceptualization of multicultural counseling competence has been a mainstay in the field of counseling psychology over the past few decades (e.g., Sue et al., 1982, 1992, 1998). However, recent theoretical models of multicultural counseling competence have attempted to expand Sue et al. s (1982, 1992, 1998) conceptualizations to be more inclusive of client-related perspectives in determining counselors multicultural competence. For example, Sodowsky, Taffe, Gutkin, and Wise (1994) proposed a four-factor model of multicultural counseling competence consisting of multicultural counseling skills, awareness, knowledge, and relationship. Furthermore, Constantine and Ladany (2001) proposed that two vital aspects of multicultural counseling competence included counselors understanding of unique client variables (e.g., clients cultural group memberships, personal values, and personality traits) and the establishment of an effective working alliance. Such expansions of the tripartite model of multicultural counseling competence have drawn specific attention to the counselor-client interface, as opposed to using counselors as the sole reference points for evaluating their multicultural counseling competence. THE Constantine COUNSELING et al. / CLIENTS PSYCHOLOGIST PERCEPTIONS / May 2002 Correspondence concerning this article should be addressed to Madonna G. Constantine, Department of Counseling and Clinical Psychology, Teachers College, Columbia University, 525 West 120th Street, Box 92, New York, NY may be sent to mc816@columbia. edu. THE COUNSELING PSYCHOLOGIST, Vol. 30 No. 3, May by the Division of Counseling Psychology. 407

2 408 THE COUNSELING PSYCHOLOGIST / May 2002 Pope-Davis et al. (2002 [this issue]) have joined the ranks of several scholars in underscoring the importance of ascertaining clients perspectives about what constitutes effective multicultural counseling. In light of the growing cultural diversity in the United States, clients perceptions with regard to the counseling services they receive have been increasingly recognized as valuable and crucial (Constantine, in press). In fact, when clients perceptions of therapeutic services are not considered, the evaluation of services is incomplete and biased toward counselors own perspectives (Gaston & Sabourin, 1999; Larsen, Attkisson, Hargreaves, & Nguyen, 1979; Paulson, Truscott, & Stuart, 1999). Pope-Davis et al. s major contribution appears to add a vital piece to the ongoing conversation regarding ways to best assess multicultural counseling competence. In reacting to their article, we will (a) discuss its strengths and relevance to the area of multicultural counseling competence, (b) identify potential concerns related to its presentation, and (c) delineate future directions for counseling psychology training, clinical practice, and research. STRENGTHS Pope-Davis et al. s (2002) study represents a hallmark contribution that examines clients perceptions of what constitutes cultural competence, and we are pleased to note its numerous strengths. First, a primary strength of Pope-Davis et al. s research lies in its attempt to solicit clients perceptions of counselors multicultural competence through qualitative methodology. It is one of the first of its kind to examine clients experiences in this vein. In addition, the methodology section was clearly described, and special attention was paid to reliability issues in their research through the use of triangulation procedures, the articulation of potential research biases, and intensive training procedures. An additional strength of Pope-Davis et al. s (2002) study is that it underscored the importance of counselors being acutely attentive to clients needs and understanding how these needs may affect clients involvement in counseling. Moreover, the different components of their multicultural competence model are interesting and are presumed to be interrelated processes. One of the components of their model, client-counselor relationship, echoes a theme represented in prior conceptualizations of multicultural counseling competence (e.g., Constantine & Ladany, 2001; Sodowsky et al., 1994). Thus, their study lends some empirical support for expanding the conceptualization of multicultural counseling competence to include the counseling relationship.

3 Constantine et al. / CLIENTS PERCEPTIONS 409 With regard to Pope-Davis et al. s (2002) findings, we were also struck by some clients perceptions that, at times, they worked with a counselor who did not understand their ethnic backgrounds or cultures but who was competent in other clinical areas. It was sad to think that perhaps some clients believed they could not have a counselor who was both multiculturally knowledgeable and who possessed general clinical competence. However, some of these clients reported that their counselors lack of cultural understanding was not an obvious impediment to the development of an effective working alliance. In addition, it was disheartening (but important) to note that some clients blamed themselves for their counselors lack of cultural understanding or empathy. In these situations, it is possible that counseling served to create new or additional psychological baggage for some individuals instead of assisting them in making desired life changes. Pope-Davis et al. (2002) also highlighted how clients may play an integral role in how cultural issues are discussed and explored in counseling relationships. Although some clients of color, for example, may not choose to bring up cultural issues in the context of counseling, it seems important that counselors possess the willingness to bring up such issues, even if only initially as a means of communicating to clients that they are aware of cultural similarities and differences in the therapeutic relationship. Clients may then be able to determine the extent to which discussions about cultural issues will play a role in their therapeutic work. Another important observation made by Pope-Davis et al. (2002) was their recognition that clients perceptions may change dramatically as counseling progresses. Thus, it seems beneficial for counselors to assess clients perceptions of counseling at different points during the therapeutic relationship to make necessary treatment modifications. If counselors evaluated the extent to which they were being effective only at the termination of counseling, then clients may not benefit as fully as they might if their counselors solicited regular feedback about their work with clients. POTENTIAL CONCERNS Although there are several strengths of Pope-Davis et al. s (2002) contribution, there are some issues that may need to be considered or discussed within the context of their theoretical model. First, one of the core assertions of their study, that clients perspectives should be used to assess and define multicultural counseling competence, could be stated with a caveat. Specifically, although their model is rooted in the notion that counselors multicultural competence is based partially on clients perceived needs, it is impor-

4 410 THE COUNSELING PSYCHOLOGIST / May 2002 tant to note that some clients may not accurately recognize their central issues and needs. For example, a married female immigrant client who was reared in a very patriarchal culture and who articulates that her primary therapeutic goal is to tolerate my husband s physically and verbally abusive behavior will not benefit from a counselor who actually helps her to meet this expressed goal. Rather, it may be more productive for the counselor to help the client to identify ways to achieve physical and emotional safety in light of her presenting concerns. In the aforementioned example, a multiculturally competent counselor might recognize the importance of attending to the cultural components of this client s presenting concern, but the client herself may not necessarily appreciate or value the revised goals encouraged by her counselor. Hence, in the context of this scenario, the potential over-reliance on the client s perceptions of her counselor s competence may lead to inaccurate assessments of the counselor s true competence because the client may be unable to see the benefits of the counseling focus offered by her counselor. It was also difficult for us to understand fully how to apply Pope-Davis et al. s (2002) proposed model to clients. Thus, a case example illustrating the application of this model might have been helpful. Furthermore, we found some components of the model to overlap somewhat. For example, how is the client-counselor relationship component of the model fundamentally different from the client processes component of the model? In discussing our thoughts about their major contribution, we imagined that Pope-Davis et al. s data categorization process was extremely arduous and that the criterion for each component was very specific. However, based on the definitions provided, some components of the model may need to be collapsed because of this potential overlap. That is, if the client-counselor relationship component and the client processes component are a bit difficult to tease apart both theoretically and in an applied sense, then perhaps these two components could be integrated. We also wondered about the sampling methodology and criteria by which potential participants of Pope-Davis et al. s (2002) study were selected and eliminated. For example, we thought that the authors could have further justified the study s inclusion criterion of meeting with a counselor for more than an intake session. The psychological literature is replete with investigations demonstrating that people of color, for example, may terminate after the first counseling session because of issues such as perceived cultural insensitivity on the part of counselors or cultural mistrust concerns. Hence, because cultural incompetence may contribute to premature termination of counseling, the perspectives of clients who terminate after the first session may also be important to obtain in better understanding clients perspectives regarding effective multicultural counseling. By eliminating this population in their study, some vital data may have been lost or sacrificed.

5 Constantine et al. / CLIENTS PERCEPTIONS 411 Pope-Davis et al. (2002) also may have wished to provide more detail about how clients racial and cultural identities may interact with those of their counselors and how these identities may be manifested within counseling dyads. For instance, Helms s (1984, 1990, 1995) interactional process model delineates potential dynamics that occur when counselors and clients interact and shows how these interactions influence the perceived quality of counseling. Thus, in applying Helms s therapy process model to Pope-Davis et al. s findings, if a client operated at a more advanced racial/cultural identity status than her counselor, which defines a regressive relationship in Helms s interactional model, the client may describe counseling as unsatisfying to her if racial/cultural issues were salient to her presenting problems and were not discussed. Conversely, if a counselor were operating at a similar racial/ cultural identity status to her client (i.e., a parallel relationship), the client might report greater satisfaction with counseling if racial/cultural issues were primary considerations in relation to her presenting issues and were addressed sufficiently in counseling according to the client. FUTURE DIRECTIONS FOR COUNSELING PSYCHOLOGY TRAINING, CLINICAL PRACTICE, AND RESEARCH Pope-Davis et al. s (2002) study raised several salient issues concerning the area of multicultural counseling competence. In the following sections, we propose future directions for multicultural training, counseling, and research in light of their findings. Training Directions There are existing models of multicultural counseling that have not been sufficiently researched but that may represent optimal models by which to train multiculturally competent counselors. For example, Atkinson, Thompson, and Grant s (1993) three-dimensional model of multicultural counseling provides a structure for understanding certain client variables or issues within the helping process, and it provides information about eight important helper roles that counselors could assume in working with culturally diverse individuals. These roles include adviser, consultant, advocate, change agent, facilitator of indigenous support systems, facilitator of indigenous healing methods, counselor, and psychotherapist (see Atkinson et al., 1993, for a thorough explication of these roles). Pope-Davis and colleagues (2002) major contribution seemed to stress the importance of counselors being flexible in adopting various roles in working with clients to effectively meet their

6 412 THE COUNSELING PSYCHOLOGIST / May 2002 mental health needs. However, most counselor training programs neglect to teach students to develop helping skills employed in professional roles other than those of counselor and psychotherapist. Hence, the degree to which counselors-in-training are equipped to work with an increasingly diverse population of individuals in the United States appears to be limited. For example, a young, Dominican American, single mother living in a homeless facility who seeks help from a counselor to navigate the welfare system could have some chronic and debilitating psychological problems, but her presenting immediate concerns may not be best met with some traditional (e.g., insight-oriented) counseling interventions. In the aforementioned example, a multiculturally competent trainee or counselor might recognize that serving as an adviser, consultant, advocate, and/or facilitator of indigenous support systems might better suit this client s current needs. Thus, it seems especially important that counselor training programs consider ways to prepare students to assume a broader range of helping roles in working with culturally diverse individuals. Pope-Davis et al. s (2002) investigation also pointed to the need for counselor training programs to provide various cultural immersion experiences to help trainees develop sensitivity to the needs of diverse populations, increase their awareness of their own cultural biases, and serve future clients more effectively. Given some clients views of their counselors as possessing cultural competence in Pope-Davis et al. s (2002) study, it is likely that some of these counselors had contact with culturally different others that positively affected the quality of their clinical interactions and interventions with these clients. Because contact with culturally diverse others has been heralded as a training technique to reduce interracial prejudice (Diaz-Lazaro & Cohen, 2001) and as a correlate of self-reported multicultural counseling competence (e.g., Sodowsky et al., 1994; Sodowsky Kuo-Jackson, Richardson, & Corey, 1998), it seems important to determine in future studies how specific interpersonal processes in cross-cultural situations may affect counselor trainees awareness and knowledge of cultural issues. Such information could help trainers to determine the most effective ways of aiding future counselors to intervene successfully with diverse cultural populations. In culturally homogenous geographical areas, however, opportunities for trainees to participate in certain cultural immersion experiences may be limited. With advances in technology that have been utilized in distance-learning programs via the Internet (Ancis, 1998), trainees of varied cultural backgrounds may be able to engage in modified immersion experiences. Although there are several limitations to utilizing distance learning (e.g., no face-toface contact, audio and video interference) (Ancis, 1998), such an addition to training programs may serve to enhance some trainees exposure to multicultural populations.

7 Constantine et al. / CLIENTS PERCEPTIONS 413 Clinical Practice Directions With regard to future counseling directions, Pope-Davis et al. s (2002) findings emphasized the notion that some psychological issues raised by clients are not primarily racial or cultural in nature. Although racial, ethnic, and gender variables, for example, are vital factors that should be considered in gleaning clients perspective of their presenting issues, certain cultural variables may have more or less relevance for clients at certain points. Hence, Pope-Davis et al. s results, in part, speak to the importance of counselors identifying the degree to which clients differing cultural identities may hold varying levels of salience in their lives at different times. For example, an African American female client whose counselor is focusing almost exclusively on racial factors or issues in counseling, at the expense of more salient gender issues, may view her counselor as promoting her own personal agenda instead of assisting the client in exploring and resolving her presenting issues. Another potential clinical practice direction based on Pope-Davis et al. s (2002) study pertains to the need for counselors to better understand how unique client variables may relate to or affect counselors multicultural competence. For example, clients motivation for treatment may largely determine the extent to which counselors are effective in addressing these clients presenting concerns. Moreover, clients personality traits and values are presumably important factors to consider in the context of evaluations of multicultural counseling competence. Thus, the impact of a broad range of unique client variables may need to be recognized as vital to the assessment of counselors multicultural counseling competence via self-report and third-party ratings (Constantine & Ladany, 2001). Research Directions Pope-Davis and his associates (2002) found that when clients reported that they did not perceive culture as a central issue, they were more lenient toward their counselors cultural incompetence when therapeutic impasses developed. Hence, further research may be needed to explore the psychological effects of client leniency on various counseling processes and outcomes. For example, research directions in this regard could address the following questions: What are the emotional and cognitive costs to clients with regard to forgiving counselors cultural insensitivities? How do these costs affect the nature of the therapeutic relationship? Furthermore, what are the characteristics of clients (e.g., low self-esteem, less advanced racial identity attitudes) who may blame themselves for the cultural ignorances and insensitivities of their counselors?

8 414 THE COUNSELING PSYCHOLOGIST / May 2002 Another potential future research direction in this vein may relate to the possibility that certain therapeutic modalities or approaches could contribute to or perpetuate a lack of cultural awareness or knowledge in counseling more so than other approaches. For example, Constantine (2001) reported that school counselor trainees with an eclectic/integrative theoretical orientation reported significantly higher levels of multicultural counseling competence than did trainees with psychodynamic and cognitive-behavioral theoretical orientations. These findings may suggest that counselors flexibility in utilizing perspectives and techniques from various counseling theories may reflect their competence in working with culturally diverse individuals to some degree. However, future research will be needed to explore such findings more fully to better understand the role of theoretical orientation in the development and maintenance of counseling relationships. Pope-Davis et al. s (2002) findings also emphasized the need to examine the extent to which client and counselor similarities and differences may affect the development of therapeutic relationships. That is, are there optimal levels of client and counselor similarities and differences that may allow clients to gain greater therapeutic benefits? Moreover, are these similarities and differences more pronounced depending on whether or not they are culturally based? One of the issues raised by Pope-Davis et al. s study (2002) related to the ongoing discussion about the overlap between the constructs of multicultural counseling competence and general counseling competence. There are two dominant queries within this issue: (a) Are general counseling competence and multicultural counseling competence two distinct constructs of professional capacity? and (b) Does Sue et al. s (1982, 1992, 1998) tripartite conceptualization of multicultural counseling competence fully encompass this construct? Although some preliminary research has revealed that multicultural counseling competence may overlap significantly with general counseling competence (e.g., Coleman, 1998; Constantine, in press; Fuertes & Brobst, in press), it will be important for future investigators to identify specific components of each construct that may be similar and different. It will also be vital for future researchers to establish links between process and outcome variables as they relate to the evaluation of counselors multicultural counseling competence (Constantine, in press). Pope-Davis et al. s (2002) investigation highlighted the dynamic exchanges and creations of meaning that exist in counseling relationships, particularly with regard to cultural factors that may affect clients self-disclosure, such as identification with counselors, cultural norms about disclosure, and counselor sensitivity. Future researchers may wish to determine specifically how other cultural variables, such as cultural mistrust and racial identity attitudes, may affect clients levels of self-disclosure. Furthermore, investigating the extent to

9 Constantine et al. / CLIENTS PERCEPTIONS 415 which clients cultural values are related to their self-disclosure and other counseling behaviors may be important. Last, Pope-Davis and colleagues (2002) findings identified the strong need for empirical research that examines counseling dyads to increase our understanding of issues that affect multicultural counseling processes and outcomes. The results of such research might inform the determination of optimal or effective client-counselor pairings. In addition, incorporating both clients and counselors perspectives of counseling may be key to formulating a more comprehensive conceptualization of multicultural counseling competence. That is, relying on information from both members of counseling dyads may allow researchers to derive more accurate determinations of counselors ability to address their clients concerns in a culturally competent manner. REFERENCES Ancis, J. R. (1998). Cultural competency training at a distance: Challenges and strategies. Journal of Counseling and Development, 76, Atkinson, D. R., Thompson, C. E., & Grant, S. K. (1993). A three-dimensional model for counseling racial/ethnic minorities. Counseling Psychologist, 21, Coleman, H.L.K. (1998). General and multicultural counseling competency: Apples and oranges? Journal of Multicultural Counseling and Development, 26, Constantine, M. G. (2000). Social desirability attitudes, sex, and affective and cognitive empathy as predictors of self-reported multicultural counseling competence. The Counseling Psychologist, 28, Constantine, M. G. (2001). Theoretical orientation, empathy, and multicultural counseling competence in school counselor trainees. Professional School Counseling, 4, Constantine, M. G. (in press). Predictors of satisfaction with counseling: Racial and ethnic minority clients attitudes toward counseling and ratings of their counselors general and multicultural counseling competence. Journal of Counseling Psychology. Constantine, M. G., & Ladany, N. (2001). New visions for defining and assessing multicultural counseling competence. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (pp ). Thousand Oaks, CA: Sage. Diaz-Lazaro, C. M., & Cohen, B. B. (2001). Cross-cultural contact in counseling training. Journal of Multicultural Counseling and Development, 29, Fuertes, J. N., & Brobst, K. (in press). Clients perceptions of counselor multicultural competency. Cultural Diversity and Ethnic Minority Psychology. Gaston, L., & Sabourin, S. (1992). Client satisfaction and social desirability in psychotherapy. Evaluation and Program Planning, 15, Helms, J. E. (1984). Toward a theoretical explanation of the effects of race on counseling: A Black and White model. The Counseling Psychologist, 12, Helms, J. E. (1990). Counseling attitudinal and behavioral predispositions: The Black/White interaction model. In J. E. Helms (Ed.), Black and White racial identity: Theory, research and practice (pp ). Westport, CT: Greenwood. Helms, J. E. (1995). An update of Helms s people of color and White racial identity models. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (pp ). Thousand Oaks, CA: Sage.

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