___________________________________ Code of Ethics for Counselors and Marriage and Family Therapists
There are many cultural beliefs and experiences that influence diagnosis, and the DSM-5-TR revision in 2022 incorporated greater cultural sensitivity and understanding in the diagnostic process [14]. Some changes implemented in DSM-5-TR include language that challenges the view that races are discrete and natural entities: • The term “racialized” is used instead of “race/racial” to highlight the socially constructed nature of race. • The term “ethnoracial” is used in the text to denote the U.S. Census categories, such as Hispanic, White, or African American, that combine ethnic and racialized identifiers. • The terms “minority” and “non-White” are avoided because they describe social groups in relation to a racialized “majority,” a practice that tends to perpetuate social hierarchies. • The emerging term “Latinx” is used in place of Latino/Latina to promote gender-inclusive terminology. • The term “Caucasian” is not used because it is based on obsolete and erroneous views about the geographic origin of a prototypical pan-European ethnicity. • Prevalence data on specific ethnoracial groups were included when existing research documented reliable estimates based on representative samples. In addition, information is provided on variations in symptom expression, attributions for disorder causes or precipitants, and factors associated with differential prevalence across demographic groups. Cultural norms that may affect the level of perceived pathology are also reported. Attention was paid to the risk of misdiagnosis when evaluating individuals from socially oppressed ethnoracial groups. Clearly, it is impossible to be an expert in working with all cultures. Many researchers in this field report that it is impor- tant to look at the universal principles and standards that are at the core of therapy and counseling. These are basic human rights, and promoting an individual’s mental health to reach full potential is fundamental. A counselor should work beyond their cultural beliefs and social systems and strive to understand clients from their viewpoints. A counselor must be aware of a client’s external influences that may impact the development of service plans. There are many training and educational programs to help build competence in multicultural diversity and to help the practitioner appreciate the social and cultural influences that shape a client’s view of the world. Practitioners who do not consider these influences may incorrectly evaluate, or label, the client. They risk diagnosing behavior as pathological or impaired, although it may be an accepted and normal practice in the client’s culture.
Multicultural awareness in counseling and therapy is critical for the counselor or therapist to communicate effectively in a way that is culturally sensitive. The practitioner must consider the effects of the client’s culture in all phases of the service plan to deliver effective, individualized service. In addition to training and educational programs, practitioners should increase their own multicultural competencies through hands-on experiences with local cultures in their communi- ties of practice. This could include attending special events; volunteering; consulting professionals in the community; and participating in workshops, advocacy programs, and discussion groups along with consulting supervisors or other colleagues who have experience with the community. These activities, combined with guidelines from the code of ethics, may help practitioners develop competencies to further serve clients from diverse cultures. Practitioners must identify and understand their own cultural perspective as it impacts their practice with diverse popula- tions. While there may be situations that show blatant discrimination toward others or ignorance of other cultures, many cultural insensitivities or negative behaviors have been termed “micro- aggressions,” which are defined as, “A comment or action that subtly and often unconsciously or unintentionally expresses a prejudice” [15]. Well-meaning therapists who believe that they are culturally sensitive and open minded may offend members of another culture without being aware that they are doing so. Micro-aggressions are linked to implicit bias (see glossary) that may be subtle, unconscious, and unintentional as well. According to the APA, [16]: • Implicit bias is thought to be shaped by experience and based on learned associations between particular qualities and social categories, including race and/ or gender. • Individuals’ perceptions and behaviors can be influenced by the implicit biases they hold, even if they are unaware they hold such biases. • Implicit bias is an aspect of implicit social cognition: the phenomenon that perceptions, attitudes, and stereotypes can operate prior to conscious intention or endorsement. Therapists and counselors must be careful to identify their potential for bias and stereotyping clients from other cultural backgrounds and should complete implicit bias training as part of their professional preparation for practice. Nontraditional Family Groups Today’s professional will encounter a variety of nontraditional families and groups. Same-sex or transgender parents; same-sex family members; and biological, surrogate, and stepparents and -children are all within these nontraditional family groups.
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