Listen to the presentation for FREE on the Counselor Toolbox podcast or watch the video on our youtube channel https://youtube.com/allceuseducation. Sign up for Counseling CEU webinars at https://www.allceus.com/live-interactive-webinars/

1. Improving Cultural Competence
Working with Native Americans
and Alaskan Natives
Instructor: Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC
Executive Director: AllCEUs.com Counselor education
Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 1

2. Objectives
 Explore questions to consider when developing the case
formulation and treatment plan
 Examine demographics, prevalence of problems, health
disparities, historical contributors to problems
 Learn about specific Native American values, communication
guidelines, worldview differences, differences in approaches to
treatment, perspectives on health and healing, culture bound
syndromes and approaches which may be helpful with this
population.
 Learn how mapping the client’s cultural views and influences
can help clinicians (and clients) develop insights into current
struggles and clarify culturally relevant goals
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 2

3. General Demographics and Information
 There are 566 federally recognized American Indian Tribes, and their
members speak more than 150 languages
 Numerous other Tribes recognized only by states and others that still
go unrecognized by government agencies of any sort.
 Native Americans who belong to federally recognized Tribes and
communities are members of sovereign Indian nations that exist
within the United States. On lands belonging to these Tribes and
communities, Native Americans are able to govern themselves
 Health care is provided to many Native Americans on reservations by
Indian Health Services (IHS),
 Native Americans, by virtue of their membership in sovereign Tribal
entities, have rights that are different from those of other Americans
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 3

4. Prevalence of Problems
 28.3 percent of American Indians and Alaska Natives report having a
mental illness, with approximately 8.5 percent indicating serious mental
illness in the past year
 Native Americans were nearly twice as likely to have serious thoughts of
suicide as members of other racial/ethnic populations, and more than 10
percent reported a major depressive episode in the past year.
 Common disorders include depression, anxiety, and substance use.
 PTSD comparison rates taken from the AI-SUPER PFP study show that
12.8 percent of the Southwest Tribe sample met criteria for a lifetime
diagnosis of PTSD compared with 4.3 percent of the general population
 American Indians and Alaska Natives have the second highest infant
mortality rate in the Nation (National Center for Health Statistics, 1999)
and the highest rate of sudden infant death syndrome
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 4

5. Educational Problems
 Less likely than other Americans to graduate high school
or complete a college degree
 American Indian students achieve on a par with or beyond the
performance of non-Indian students in elementary school and show
a decline in performance between fourth and seventh grades
 AI children may have a culturally rooted way of learning
at odds with teaching methods currently used in public
education.
 AI children are primarily visual learners, rather than auditory or
verbal learners.
 Academic crossover is paralleled by a similar trend in
mental health status, as extrapolated from rates of child
and adolescent outpatient treatment.
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 5

6. Poverty
 The poverty rate for America as a whole is 14.3%
(Center for Poverty Research), for Native Americans
the rate is about 26%
 Native Americans have the lowest employment rate of
any racial or ethnic group in the United States
(Bureau of Labor Statistics, 2012).
 In the poorest Native counties, only about 1/3 of men
in Native American communities have full-time, year-
round employment.
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 6

7. Historical Contributors to MH/SA
 Historical reasons for the development of binge
drinking among Native Americans.
 The existence of dry reservations (which can limit the times
when individuals are able to get alcohol)
 High levels of poverty
 Lack of availability (e.g., In remote Alaskan native villages)
 A history of trauma
 The loss of cultural traditions
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 7

8. Historical Contributors to MH/SA
 Issues impacting parenting & prevention which can lead to
increased neglect and abuse:
 Due to past separation from their families, when these children
become parents themselves, they are not able to draw on
experiences of growing up in a family to guide their own parenting
 Poverty and demoralization
 Rapid cultural change
 These issues also increase the risk for domestic violence, spousal
abuse, and family instability, with their attendant negative mental
health effects
 6 in 10 American Indian and Alaska Native families were
headed by married couples vs. 8 in 10 of the Nation's
other families https://www.ncbi.nlm.nih.gov/books/NBK44242/
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 8

9. Health Disparities
 Heart disease
 Cancer
 Unintentional injuries
 Diabetes
 Depression, anxiety, PTSD and suicide
 Obesity
 Substance abuse
 Sudden infant death syndrome (SIDS)
 Teenage pregnancy
 Liver disease
 Hepatitis.
 60% higher infant mortality rate than Caucasians
 5.8 tuberculosis rate compared to 2.0 for Caucasians (2010)
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 9

10. Health Disparities
 Diabetes is increasing among Native Americans, and approximately 38
percent of elder Native Americans have diabetes
 Diabetes is also associated with both substance use disorders and
depression
 In some Native American communities inhalants have been a major
drug of abuse for adults as well as youth.
 During the early 1990s, about 46 percent of the adult population on that
reservation were thought to abuse inhalants
 Native Americans are about 1.4 times more likely than White
Americans to have a lifetime diagnosis of an alcohol use disorder
 Illicit drug use is also more common for Native Americans than for
members of other major racial/ethnic groups.
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 10

11. Cultural Considerations in Approaches
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 11

12. Specific Native American Values
 Native Americans generally value the community’s best
interests over their own interests (collectivistic).
 When an individual is experiencing problems it interferes
with his or her ability to fulfill his or her role in the
community.
 Many believe that addiction or mental health problems
hurt and weaken the community.
 This collectivistic role can increase motivation for change
by inspiring clients to change for the good of the tribe and
for the good of the next seven generations to come, even
if they don’t want to change for themselves.
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 12

13. Worldview Differences in MH Treatment
AIAN
 Relational
 Mind/Body/Spirit is one
 Mysticism/Acceptance
 Ceremonies/Rituals
 Tribal Connectedness
 Spirituality and Balance
 Cooperation/Sharing
 Patience/Respect
 Present Orientation
 Healing through Herbs, Plants,
Nature
Majority
 Linear Point A to Point B
 Psyche is the focus
 Science/Verification
 Psychotherapy
 Individualism
 Organized Religion
 Competition/Winning
 Assertiveness/Forcefulness
 Future Orientation
 Psychopharmacology
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 13

14. Communication Guidelines
 You should know someone well before speaking to them
for long periods of time or confiding in them
 Children should not display themselves verbally in front of
adults.
 It is inappropriate to express emotions in public or around
people you don't know very well, verbally or non-verbally.
 Don’t ask direct questions or expect an immediate
response from people you don't know very well.
 It is inappropriate to verbally discipline or praise a child
in public.
 It is inappropriate to speak for someone else, no matter
who that person is. Everyone is titled to their own
opinion, even a child.
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 14

15. Communication Guidelines
 "In Indian conversations, it is not the person who
speaks first who necessarily controls the topic. This is
because an immediate response to what someone ha
said may be delayed. The respondent therefore has
control over the topic by choosing when to speak and
what to say.“
 Do not signal someone out directly
 Do not compete with answers, no answer can be said
it is wrong
 Do not look directly at someone the entire time they
are talking.
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 15

16. Specific Native American Values
 Be careful when bringing up the topic of spirituality, as there
are sacred and secret traditional practices and spiritual leaders
who have the role of providing guidance and healing.
 Many Native communities have long histories of contact with
missionaries. They may have adopted, rejected or blended
Christian beliefs with their own Native beliefs.
 In general, belief in the Creator, Grandfather, God, gods or a
higher power is central to many Native people.
 For some Native Americans, spirituality is an integral part of
who they are and the world around them.
 Native healers do not separate mind, body and spirit but see
them all as connected.
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates
16

17. Native Americans & Addiction Cause & Tx
 Some believe that addiction is a spiritual entity that has its own
voice. The spirit of addiction tries to seduce or tempt the person to
drink or use other substances and sometimes is the only way people
know how to cope with their problems. Eduardo and Bonnie Duran wrote about
addiction as a spirit in their book, “Native American Postcolonial Psychology.”
 Native American recovery movements viewed addictions as a result of
cultural conflict between Native and Western cultures, seeing
substances as weapons that have caused further loss of traditions
 To best treat this population embrace a broader view that explores
the spiritual, cultural, and social ramifications of substance abuse
 Talking about how current behaviors interfere with their spirituality
may help increase client’s motivation to make positive changes
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 17

18. Differences in Mental Health Approaches
ANAI
 Focus on health and positive words
 Counseling ability may be an inborn
gift, developed in dreams and visions
and through apprenticeship
 Egalitarian view that all people have
challenges. Transference is
uncommon
 Oversight by the community
 Humor
 Healing accomplished through
insight, interpretation, plant
medicine, prayer, ceremony, and
transpersonal help from spiritual
powers
Western Methods
 Focus on diagnosis and disease
 Counseling ability taught through
internship and academics
 Heirarchical view. Transference
common.
 Oversight by licensing boards
 Interventions have a serious tone
 Healing accomplished through
insight, interpretation, and/or
medication
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 18

19. Differences in Mental Health Approaches
ANAI
 Therapy practiced ion nature or a
sanctified place
 1-4 sessions on successive days
 Advertising is unethical
 Selfless generosity of healer and
patient promotes healing and
outcome
 Sessions have no fixed length
 Massage and laying of hands may be
part of treatment
 Focus on returning to a state of
confidence, balance, beauty, well-
being, and harmonious family and
community relations
Western
 Therapy practiced in an office
 Treatment is prolonged
 Advertising is a key to success
 Fixed fee for services
 Fixed length sessions
 No touching
 Focus on coping with, managing, or
curing mental disease
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 19

20. Beliefs About Illness and Healing
 Native American medicine is a complete system that addresses
both healing and cure.
 Health requires balance in every sphere of one’s life, from the
most personal inner world to lifestyle and social connections.
 Disease is not defined by physical pathology, but viewed from an
expanded context that includes body, mind, spirit, emotions,
social group, and lifestyle.
 Native American medicine works by returning the individual to a
state of balance both within himself and in relationship to the
outer world.
 Native medicine places the roots of any imbalance in the world of
spirit. Spiritual interventions are thus seen as critical to the
success of any treatment plan.
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates
20

21. Beliefs About Illness and Healing
 This holistic approach seeks to create a change not only in pathology,
but also in:
 The patient’s understanding
 Attitude towards healthier self-concept
 Appreciation of the world around him.
 Such growth supports the patient in necessary behavior modifications.
 The healer’s intention is that the person be not simply cured of a
disease, but transformed through the experience of disease.
 Someone in need of healing looks for a practitioner who has been
successful in similar situations.
 The healing elder is the culture’s primary access to healing power. In a
system without technology and standardized practice, the responsibility
for treatment failure falls squarely on the practitioner
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 21

22. Examples of Opening Ceremonies
 Although indigenous people differ greatly from one another, these
examples of ceremonies emphasize similarities in creating a safe
space where everyone feels respected and honored.
 It was suggested that if we provided a prayer, song and ceremony for
MI, that Native people might have an easier time deciding whether to
adopt it. (Example is provided in the MI Guideline)
 Pueblo Example Opening Ceremony
 The “ceremony” is an attempt to bring sacredness to the healing process when
initially meeting with your clients, acknowledging that we are entering a
special space. As we enter this space we leave all of our bad feelings and
anger on the outside. We enter this space, where we will be interacting, with
a clear mind and heart. We say our prayers asking our ancestors for their
wisdom and help so that we may have a successful gathering. We ask the
Ancient Ones to bring good energy, healing energy, into our space and our time
together. We put our thoughts and healing feelings together and become one.
~Based on Nadine Tafoya’s experience
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 22

23. Examples of Opening Ceremonies cont…
 Maori (Aboriginals of New Zealand)
 When Maori people invite outsiders (even other Maori
communities) into their Marai (special building for spiritual
and community activities), they use a ceremony that
reminds everyone that we are all one, that everyone is safe
within the Marai, and that we all have the same goals.
 Each group introduces themselves and lets the other know
that they come in peace. There is a specific process of
talking back and forth and singing. Near the end of this
welcoming ceremony, each person from each group greets
the other. The men touch noses, thereby breathing the same
air and signifying that they are one. The women usually kiss
the cheek. Then everyone goes to have tea and eat together.
~Based on Kamilla Venner’s experience
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 23

24. Examples of Opening Ceremonies cont…
 Northwest Canadian Tribe (De Cho)
 Everyone is asked to stand up and form a circle. The
leader addresses the people and emphasizes the
importance of greeting and honoring each other and
acknowledging that we are all one in the world. The
circle evolves into two circles that are connected. The
person in the inner circle is the introducer while those
in the outer circle listen. After you introduce yourself,
you move into the outer circle. The first person begins
to show the others what to do while music plays (in this
case, a CD playing the song, “O Siem”, translated “We
are all family”, by Susan Aglukark, an Inuit woman).
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 24

25. Adaptations Example
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 25

26. Culture Bound Syndromes
 Most “culture-bound” syndromes associated w/ Native Americans
eliminated from DSM V
 Ghost Sickness (Navajo)
 People that are preoccupied and possessed by the deceased are considered to
have Ghost Sickness. Its symptoms include general weakness, loss of appetite,
feeling suffocated, having recurring nightmares, and an everlasting feeling of
terror. It is believed that if the deceased did not get proper burial rights, their
spirit would be doomed to remain on the living plane, staying to torture the
living.
 Windigo Psychosis
 “The Windigo is a figure in Northern Algonquin mythology, a fierce
supernatural cannibal able to infect humans and make them into cannibalistic
creatures by turning their hearts into ice. Windigo Psychosis occurs when a
person becomes filled with anxiety that they are becoming a Windigo, and
may increasingly view those around them as edible. The person also complains
of poor appetite, nausea and vomiting, and may become suicidal or
homicidal.” 26

27. Culture Bound Syndromes
 Heartbreak Syndrome
 Pibloktoq (arctic hysteria)
 Soul loss
 iich’ aa (moth madness (Navajo))
 “Frenzy” witchcraft (Navajo)
 Fatigue from thinking too much
 From Thomason, T. (2014). “Issues in the Diagnosis of Native
American Culture Bound Syndromes. Arizona Counseling Journal
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 27

28. Barriers to Treatment
 American Indian women listed mistrust as one of the primary barriers
for seeking treatment. This is due, in part, to the women's belief that
they would encounter people they knew among treatment agency
staff; they also doubted the confidentiality of the treatment program.
 Many Native Americans believe that recovery cannot happen for
individuals alone and that their entire community has become sick.
 Coyhis calls this the “healing forest” model: one cannot take a sick tree from
a sick forest, heal it, and put it back in the same environment expecting that
it will thrive. Instead, the community must embrace recovery.
 Access. IHS is only on reservations, where about 20% of the AI/NA
live.
 Lack of AI/NA/AN as service providers
 Culturally insensitive practices
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 28

29. Approaches
 Community approaches often lead to:
 A reduction of substance use.
 Breaking intergenerational cycles of alcohol abuse.
 Increased community support.
 The strengthening of individual and group cultural identity.
 Leadership development.
 Increased interpersonal and inter-Tribal problem-solving skills and solidarity.
 Native American cultural groups generally believe that health is
nurtured through balance and living in harmony with nature and the
community
 They also, for the most part, have a holistic view of health that
incorporates physical, emotional, and spiritual elements, individual
and community healing, and prevention and treatment activities
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 29

30. Approaches
 Culture is the path to prevention and treatment.
 Culturally responsive treatment should involve community
events, group activities, and the ability to participate in
ceremonies to help clients achieve balance and find new insight
 Recommend Motivational Interviewing, CBT and social learning
approaches for Native American clients, which have
 Less cultural bias
 Focus on problem-solving and skill development
 Emphasize client strengths and empowerment
 Recognize the need to accept personal responsibility for change
 Make use of learning styles that many native americans find culturally
appropriate
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 30

31. Approaches
 many traditional healing activities and ceremonies
have been made accessible during treatment or
effectively integrated into treatment settings
 See The Book of Ceremonies: a Native Way of Honoring and
Living the Sacred for some techniques
 These practices include
 Sacred dances
 The four circles (a model for conceptualizing a harmonious
life)
 Navajo: Hozhq encompasses the notions of connectedness,
reciprocity, balance, and completeness that underpin
contextually oriented views of health and well-being
 The talking circle
 Medicine Wheel (See Dancing with the Wheel: a Medicine
Wheel Workbook )
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 31

32. Approaches
 Practices cont…
 Sweat lodges
 the sweat is intended as a religious ceremony – it is for prayer
and healing, and the ceremony is only to be led by elders with
many years of training who know the associated language,
songs, traditions, and safety protocols.
 The ceremony can be dangerous if performed improperly.
 Sweat lodges have also been used by some non-natives
resulting in responses from Indigenous Elders declaring that it
is dangerous and disrespectful
 Indigenous cultures of Mexico and Central America have similar
practices
 Other purification practices
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 32

33. Approaches: Family Therapy
 Family Therapy: American Indians place high value on family
and extended family networks; restoring or healing family
bonds can be therapeutic
 The Native American concept of family can include elders,
others from the same clan, or individuals who are not
biologically related. In many Tribes, all members are considered
relatives.
 Family therapy models such as network therapy, which makes
use of support structures outside the immediate family and
which were originally developed for Native American families
living in urban communities, can be particularly effective with
Native clients
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 33

34. Approaches: Group Therapy
 Many Native American Tribes have traditional healing practices
that involve groups and healing needs to occur within the
context of the group or community (e.g., in talking circles).
 Thus, if properly adapted to incorporate NA traditions, group
therapy can be very beneficial and culturally congruent.
 The talking circle is a Native tradition easily adapted for behavioral
health treatment. In this tradition, the members of the group sit in a
circle. An eagle feather, stone, or other symbolic item is passed
around, and each person speaks when he or she is handed the item.
 Earn support or permission from Tribal authorities before
organizing group therapy, and consult with Native professionals.
 If group members consent, invite respected Tribal members
(e.g., traditional healers or elders) to participate in sessions.
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 34

35. Mutual Help and Support
 More Alaska Natives in recovery reported
participation in 12-Step groups than in substance
abuse treatment.
 84 percent of respondents had attended some
mutual-help meetings.
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 35

36. Mutual Help and Support
 The Lakota Tribe has adapted the 12
Steps
1. I admit that because of my
dependence on alcohol, I have been
unable to care for myself and my
family.
2. I believe that the Great Spirit can
help me to regain my responsibilities
and model the life of my forefathers
(ancestors).
3. I rely totally on the ability of the
Great Spirit to watch over me.
4. I strive every day to get to know
myself and my position within the
nature of things.
5. I admit to the Great Spirit and to my
Indian brothers and sisters the
weaknesses of my life.
6. I am willing to let the Great Spirit
help me correct my weaknesses.
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 36
 Traditional 12 Steps
1. We admitted we were powerless
over alcohol—that our lives had
become unmanageable.
2. Came to believe that a Power
greater than ourselves could restore
us to sanity.
3. Made a decision to turn our will and
our lives over to the care of God as
we understood Him.
4. Made a searching and fearless moral
inventory of ourselves.
5. Admitted to God, to ourselves, and
to another human being the exact
nature of our wrongs.
6. Were entirely ready to have God
remove all these defects of
character.

37. Mutual Help and Support
 The Lakota Tribe has adapted the 12 Steps
7. I pray daily to the Great Spirit to help me
correct my weaknesses.
8. I make an effort to remember all those that I
have caused harm to and, with the help of the
Great Spirit, achieve the strength to try to
make amends.
9. I do make amends to all those Indian brothers
and sisters that I have caused harm to
whenever possible through the guidance of the
Great Spirit.
10. I do admit when I have done wrong to myself,
those around me, and the Great Spirit.
11. I seek through purification, prayer, and
meditation to communicate with the Great
Spirit as a child to a father in the Indian way.
12. Having addressed those steps, I carry this
brotherhood and steps to sobriety to all my
Indian brothers and sisters with alcohol
problems and together we share all these
principles in all our daily lives.
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 37
 Traditional 12 Steps
7. Humbly asked Him to remove our
shortcomings.
8. Made a list of all persons we had
harmed, and became willing to make
amends to them all.
9. Made direct amends to such people
wherever possible, except when to do
so would injure them or others.
10. Continued to take personal inventory,
and when we were wrong, promptly
admitted it.
11. Sought through prayer and meditation
to improve our conscious contact with
God as we understood Him, praying
only for knowledge of His will for us
and the power to carry that out.
12. Having had a spiritual awakening as
the result of these steps, we tried to
carry this message to alcoholics, and
to practice these principles in all our
affairs.

38. Advice to Counselors
 Avoid interrupting, extensive note-taking or excessive
questioning
 Refrain from asking about family or personal matters unrelated
to the presenting issue without first asking the client's
permission to inquire about these areas.
 Pay attention to the client's stories, experiences, dreams, and
rituals and their relevance to the client.
 Remember that Native Americans are often visual learners, so
provide handouts and visual explanations
 Accept extended periods of silence during sessions.
 Allow time during sessions for the client to process information.
 Greet the client with a gentle (rather than firm) handshake and
show hospitality (e.g., by offering food and/or beverages).
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates
38

39. Advice to Counselors
 Give the client ample time to adjust to the setting at the beginning of
each session.
 Keep promises.
 Offer suggestions instead of directions (preferably more than one to
allow for client choice)
 If you are not Native or are from a different tribe, you might invite
your client to share what it is like for him or her to be working with
you as their counselor.
 Cultural differences in the expression and reporting of distress are
well established among American Indians and Alaska Natives. These
often compromise the ability of assessment tools to capture the key
signs and symptoms of mental illness. Words such as "depressed" and
"anxious" are absent from some American Indian and Alaska Native
languages ( Cultural Formulation Interview DSM V)
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 39

40. LEARN at Intake
 Listen to each client from his or her cultural perspective,
including perception of the problem and treatment preferences
 Explain the overall purpose of the interview and intake process.
 Acknowledge client concerns and discuss the probable
differences between you and your clients. Take time to
understand each client's explanatory model of illness and
health.
 Recommend a course of action through collaboration with the
client including how much involvement he or she has in the
planning process
 Negotiate a treatment plan that weaves the client's cultural
norms and lifeways into treatment goals, objectives, and steps.
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 40

41. RESPECT Clients
 Respect—Understand and reflect how respect is shown within given
cultural groups through verbal and nonverbal communications.
 Explanatory model—Devote to understanding how clients perceive
their presenting problems issues, their origin, impact and treatment
 Sociocultural context—Recognize how class, race, ethnicity, gender,
education, socioeconomic status etc. affect care.
 Power—Acknowledge the power differential between clients and
counselors.
 Empathy—Express, verbally and nonverbally, the significance of each
client's concerns so that he or she feels understood by the counselor.
 Concerns and fears—Elicit clients' concerns and apprehensions
regarding help-seeking behavior and initiation of treatment.
 Therapeutic alliance/Trust—Commit to behaviors that enhance the
therapeutic relationship; recognize that trust is not inherent but must
be earned by counselors.
• Check-in
• Walking to
office
• Intake process
A client or
consumer is a
person who
chooses to use your
services/businessAllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates
41

42. Summary
 Clinicians have to consider the impact of their “Clinical
Worldview” as well as their personal worldview on treatment
 The culturally aware counselor will reflect on the impact of
everything from the décor in the lobby to clinic procedures and
treatment selection have on the client and make every effort to
respect and empower the client to achieve wellness as he or
she defines it.
 It is important to consider the client’s worldview when
developing the case formulation
 Mapping the client’s cultural views and influences can help
clinicians (and clients) develop insights into current struggles
and clarify culturally relevant goals
AllCEUs Counselor Education $59 Unlimited CEUs | $89 Specialty Certificates 42