Multicultural Social Work Practice
Derald Wing Sue
JOHN WILEY & SONS, INC.
Multicultural Social Work Practice
Multicultural Social Work Practice
Derald Wing Sue
JOHN WILEY & SONS, INC.
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ISBN-13 978-0-471-66252-5 ISBN-10 0-471-66252-6
Printed in the United States of America
10 9 8 7 6 5 4 3 2 1
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
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
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
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 Assistant 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
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
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
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
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
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
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
Author Index 353
Subject Index 359
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-
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
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-
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
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.