African American: DSM‑5‑TR Cultural Concepts Study Guide Assignment Overview

Module2

For this assignment, use the lecture videos, DSM-5-TR (pages 859- 871), and other assigned readings to create a study guide  to define all cultural concepts identified in DSM 5 TR and Wheeler: Ch 1. p. 5-34,

Full APA 7th edition format and a minimum of 3 pages is expected. Minimum of 5 references

Please see the rubric for details.  

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Use scholarly sources to support your claims. PEER REVIEW ARTICLES ONLY. Scholarly articles from  2021 to 2026 only. (Within the last five years) Please review your spelling and the rubric. Please use North American peer-reviewed journals ONLY.DO NOT  use any European  Journal.

COURSE MATERIALS/REQUIRED TEXTS:

1. American Psychological Association. (2022). Diagnostical and Statistical Manual of mental disorders DSM 5 Text Revision. (pages 859- 871),

 

2. Sommers-Flanagan, J., and Sommers-Flanagan, R. (2018) Counseling and psychotherapy theories in context and practice: skills, strategies, and techniques (3^rd ed.). Hoboken, NJ: John Wiley & Sons, Inc. Chapter 13
3. Wheeler, Kathleen (2022). Psychotherapy for the advanced practice psychiatric nurse: a how-to guide for evidence-based practice (4^rd ed.). New York: NY: Springer Publishing Company LLC. Wheeler: Ch 1. p. 5-34,

For APA 7th edition, you can cite the Kanopy video as a film/video.

Yalom, V. (Director). (2014). Multicultural competence in counseling and psychotherapy [Film]. Psychotherapy.net.

In-text citation: Parenthetical:  (Yalom, 2014)

Narrative: Yalom (2014)

When citing a specific statement from the video: APA recommends adding a timestamp when referring to a specific part of audiovisual material: (Yalom, 2014, 11:05)

For example, traditional counseling approaches may reflect culture-bound values, such as emphasizing individualism over family or collective identity (Yalom, 2014, 11:05).

Multicultural Competence in Counseling and Psychotherapy

Transcript

00:00

VICTOR YALOM: Hello, I'm Victor Yalom.

00:02

I'm pleased to be here today with Dr. Derald Wing Sue.

00:06

He's widely acknowledged as the leading authority

00:09

in the field the multicultural counseling.

00:11

He's the co-author, along with his brother David,

00:14

of the influential and widely read textbook

00:18

Counseling the Culturally Diverse,

00:20

as well many other books– over 150 scholarly publications.

00:26

Welcome, Dr. Sue.

00:28

DERALD WING SUE: Thank you.

00:29

VICTOR YALOM: I want to talk to you today

00:31

about a wide variety of topics, but relating

00:36

to your field of multicultural counseling.

00:39

So, why don't we start more broadly.

00:42

What does that mean, multicultural counseling?

00:46

DERALD WING SUE: Well, to me it means the ability

00:50

to develop cultural competence in working

00:53

with different racial, ethnic minority groups.

00:56

And when I first started becoming interested in it,

01:00

I noted that most of the theories of counseling

01:03

and psychotherapy were white Western European in origin.

01:08

Their primarily the creation of Western European men,

01:15

which reflected a worldview that was quite

01:18

different than the worldview I was raised in, with my parents.

01:24

And it was out of that, that I began to really notice

01:28

that counseling and psychotherapy traditionally

01:31

was quite inappropriate and oppressive towards clients

01:36

of color who came in for counseling and psychotherapy,

01:39

because their worldviews were quite

01:41

different from that that most traditional forms of therapy

01:45

came from.

01:47

VICTOR YALOM: What alerted you to that?

01:50

I'm sure many things, but I think

01:53

many therapists would think that we

01:57

work with lots of different kinds of clients,

01:59

and everyone has a unique story, and part

02:02

of our core of our basic training

02:05

is to be curious, and empathic, and understanding, yet

02:09

obviously in your eyes, that wasn't enough.

02:11

So

02:12

DERALD WING SUE: No, it wasn't enough.

02:13

And much of what I've come to understand about counseling

02:19

and psychotherapy came through my own graduate training

02:22

at the University of Oregon.

02:24

I loved psychology.

02:26

I went into counseling and psychotherapy,

02:29

and loved the work of Leona Tyler, who

02:33

was then really much into career,

02:35

vocational, educational, and personal counseling.

02:40

One thing that I discovered was that much

02:44

of what they valued in terms of counseling

02:48

healthy human development was not what I was raised to be.

02:54

For example, I discovered that almost all of the professors I

02:59

had emphasize individualism as the road to mental health.

03:04

In fact, I was taught the developmental theories

03:08

of Erikson, Jean Piaget– and almost all of them, I noted,

03:13

equated healthy maturity and development

03:17

was with individuation from the group.

03:21

Now, my father and mother always emphasized

03:25

that I was part of the family.

03:27

And that individuation, while it might

03:30

be valuable in certain conditions, that

03:34

becoming an individual often times

03:36

meant that you would break away from the family

03:40

and not have the collective identity that was so valued.

03:44

As I went through graduate school,

03:47

I also began to realize that what

03:51

I read– Freudian psychology, existential,

03:55

humanistic psychology– did not resonate with what I consider

04:02

to be effective therapy with Asian Americans.

04:06

And then my first position was at the University

04:09

of California-Berkeley where I began

04:12

to do therapy with a number of Asian American clients,

04:17

and with some of the African American clients–

04:20

the students who came in.

04:23

And the types of conflicts that they went through

04:26

was not really addressed by traditional forms of counseling

04:31

and psychotherapy, and in some sense

04:33

pathologized their cultural values.

04:36

VICTOR YALOM: Such as?

04:37

DERALD WING SUE: For example, if an Asian American client came

04:43

in and you were to give them an interest inventory,

04:48

and it showed that they would be better off instead

04:52

of in electrical engineering, to be in a field like forestry–

04:57

VICTOR YALOM: So in interest then to the story,

04:59

this is in– you were doing career counseling?

05:01

DERALD WING SUE: Career coun– well, I

05:03

did a number of things– career counseling,

05:05

vocational counseling, and personal counseling.

05:09

But this is representative of an issue that goes back.

05:15

That in some sense, I would say that your strong vocational

05:20

interest inventories indicate that perhaps you're

05:22

on the wrong major, and maybe you

05:25

should think about switching into something that you're

05:29

finding more interest.

05:31

And they would say to me things like well,

05:34

before I can change my major, I have

05:37

to check with my mother and father.

05:39

And the way that I was taught was that here we

05:44

have someone who is a junior in college, becoming–

05:49

moving into adulthood.

05:51

They should be able to make decisions on their own.

05:53

And what I would be taught would be– traditional training–

05:57

was that they were dependent, immature,

06:01

and they should make this decision on their own.

06:06

And I realized that if I impose those values upon them,

06:11

I was pathologizing a cultural value in which it

06:15

was considered very appropriate to first consult

06:19

with your mother and father, or your parents, before going

06:23

on and making a decision.

06:25

VICTOR YALOM: So that was kind of a microcosm

06:27

of a real clash of worldviews.

06:29

DERALD WING SUE: Yes, and it was reinforced

06:31

when my brother Stan was at UCLA doing research

06:35

at the psychiatric institute there, in which he relaid

06:41

stories to me about psychiatrists who

06:46

would approach him and ask him, or make a comment,

06:50

we know that you're doing research

06:52

on Japanese American clients, did you

06:55

know the Japanese are the most repressed of the clients

06:58

we've ever work with?

07:00

And it was then that Stan and I formed the Asian American

07:04

Psychological Association because we

07:07

knew that among Asians, traditional Asians

07:10

especially, restraint of strong feelings

07:13

was considered wisdom and maturity,

07:16

and free expression of feelings were indeed

07:20

considered immature.

07:21

And that's why one's ability to control their feelings

07:25

and emotions, among Asians, oftentimes led

07:28

to the concept of the inscrutable Asian,

07:32

which again was an indication of pathologizing

07:36

a strong cultural value, because counseling and psychotherapy

07:40

wants our clients to freely express their feelings.

07:44

And this is considered a cultural taboo

07:46

among many Asians and Asian Americans who come in for help.

07:52

VICTOR YALOM: Yeah, so it sounds like you were quickly

07:56

confronted with the cultural biases of what is normality,

08:02

what is a positive mental health, what

08:05

is psychopathology, and how embedded that was in culture.

08:09

DERALD WING SUE: True, and with that under our belt–

08:14

Stan and I had formed, like I was saying, the Asian American

08:18

Psychological Association– he began

08:20

to do a number of major studies in the utilization

08:26

of mental health services by individuals of color

08:30

in the entire state of Washington.

08:33

And three of those groundbreaking studies

08:36

indicated several important things

08:39

that really jarred my concepts about mental health,

08:44

and began to introduce what I consider

08:47

to be a social/political element in counseling.

08:50

And that was that people of color

08:53

tended to underutilized nearly all

08:56

of these psychiatric services in the state of Washington

09:00

in proportion to their population.

09:02

The second outstanding finding was that once people of color

09:09

did go in for counseling and psychotherapy

09:11

they terminated at a rate of over 50%

09:15

after the first initial contact.

09:18

This is in marked contrast really to a less than 30%

09:23

premature termination rate among white clients who came in.

09:29

Now this led me to begin to ask the question, why is it so?

09:33

Why is it that regardless of the group–

09:37

and now I'm talking not only about Asian Americans,

09:40

the study encompassed Latino Hispanic Americans, African

09:44

Americans, and Native Americans, and white Americans–

09:48

and regardless of the four racial/ethnic groups,

09:51

they all prematurely terminated and underutilized.

09:55

So the question we had was why.

09:58

One of the things we talk jokingly entertained

10:01

was the fact that, well, people of color are mentally healthier

10:05

and don't need that type of treatment,

10:08

and are cured quicker after only one session.

10:11

We don't really believe that.

10:13

We believe that in terms of all the studies

10:16

that mental disorders and personal problems

10:22

are probably pretty equal across all racial/ethnic groups,

10:26

although they're manifested quite differently.

10:30

But when we asked that question, we

10:32

began to arrive at the answer that it

10:34

was the inappropriateness of the transactions that occurred

10:39

between the mental health professional and the culturally

10:44

diverse clients who came in for counseling.

10:47

Now this lead us to begin to talk about– what is there

10:51

about counseling and psychotherapy that

10:54

may prove antagonistic to the cultural values of all four

10:58

of these groups of color.

11:01

And we began to look at what we call culture-bound values.

11:05

For example, cultural-bound values

11:08

were things like individualism, in which psychology believes

11:12

that the psychosocial unit of operation

11:15

is the individual, while 3/4s of the world,

11:19

the psychosocial unit of operation

11:22

is the family, the group, or the collective society.

11:26

And that creates problems.

11:28

The other thing that we noted was

11:30

that most forms of counseling and psychotherapy,

11:34

even if it is cognitive behavioral in origin,

11:37

values a certain amount of insight.

11:42

That is that you're considered mentally healthier if you have

11:46

insight into your own personal conflicts,

11:48

motivations, and behaviors.

11:51

And again we realized that, for example, my father always

11:57

would, if I was anxious, his advice to me

12:01

would always be Derald, don't think about it.

12:05

Now, I was saying is he a quack?

12:08

That goes against what I was taught as a psychologist.

12:12

You think about it, you explore it, you get insight,

12:15

you introspect.

12:18

Later what I learned in terms of studies done at Berkeley

12:22

was that to traditional Chinese, the road to mental health

12:29

was the avoidance of morbid thinking.

12:31

And in fact, my father would oftentimes

12:34

say to me that you're thinking– the reason why you're

12:37

anxious is that you're thinking too much about it.

12:40

And we all know the work of Richard Lazarus at Berkeley

12:46

on stress coping, and it was in, I

12:49

think, the 1980s where it became very well known

12:52

for healthy denial as a road to mental health, which

12:56

was directly against the psycho-dynamic concepts

13:00

of insight.

13:01

And I tell people that I've always

13:04

resented Lazarus' work because he received all the credit,

13:08

and my father should have been the one that

13:10

got the credit for that.

13:14

These are culture-bound values, but there

13:17

were class-bound values.

13:19

counseling and psychotherapy has traditionally

13:22

been directed at middle, upper-class individuals.

13:26

The assumption being that you have

13:28

time to sit, and introspect, and talk about this.

13:32

People coming from poverty don't enjoy– they come in,

13:37

and what they want is, how can I feed my family?

13:40

Where can I get my next job?

13:42

How do I get medical help?

13:44

These are immediate issues that clash

13:47

with the 50 minute hour, once a week, type of work.

13:53

And the third area we looked at was that linguistic factors

13:57

oftentimes worked against culturally diverse clients who

14:03

would come in, because the primary mode of counseling

14:07

and psychotherapy is verbal behavior.

14:10

Standard English.

14:12

And what we found was that the large gap between translation

14:17

oftentimes– even if the Latino client can speak English–

14:22

the translation was totally different in terms of affect,

14:30

and types of expression, and even interpretation.

14:33

VICTOR YALOM: What do you mean that the interpretation was

14:41

different?

14:42

Are these for native speakers, or non-native speakers?

14:45

DERALD WING SUE: Well, see, this is really interesting.

14:48

People assume that if you have been born and raised

14:54

in the United States, and you're Latino,

14:57

that you should be able to master English.

15:00

Studies suggest that the acquisition of English

15:05

is even different if you have parents

15:08

that speak the language of Spanish, or Chinese.

15:15

It affects how you put together English.

15:19

And what we're finding is that if a person feels shy,

15:24

feels anxiety, there are different translations of that.

15:29

And when the client can't voice it in English, what we find

15:34

is that if you allow them to voice it in Spanish,

15:38

they tend to do better than if they're

15:41

locked into a primary linguistic interpretation.

15:47

But it's these three things that really

15:50

began to make me realize that rather than heal and liberate,

15:56

counseling and psychotherapy can be very oppressive

16:00

and make the person feel worse.

16:03

And those were the findings.

16:05

That many of the individuals who prematurely terminated

16:10

would come out and make statements like that,

16:13

you know, we felt worse.

16:15

We felt we were to blame.

16:17

VICTOR YALOM: So you went and interviewed

16:18

the people who just came in once?

16:20

DERALD WING SUE: Not that population,

16:22

but other populations that came out.

16:25

We began to talk to individuals that

16:28

had gone through counseling and therapy,

16:30

and they came out saying certain things.

16:34

One of the things is that, I just

16:36

don't feel comfortable with Dr. Smith.

16:39

He doesn't seem to be able, or she

16:42

doesn't seem to be able, to relate understand

16:45

what's going on with us.

16:48

Or they may mean, I'm not sure I can trust Dr. Smith because

16:53

of certain things that are going on.

16:56

VICTOR YALOM: So this is typically

16:57

minority clients, white therapists?

17:00

DERALD WING SUE: Yes, yes.

17:01

VICTOR YALOM: All right.

17:02

DERALD WING SUE: But the other thing

17:03

that came out in our findings were statements

17:08

that therapists tended to be color-blind.

17:12

That is that they found it very difficult

17:15

to talk about racial/ethnic cultural issues.

17:19

Many clients would say that they could

17:22

feel uncomfortable anxiety from the therapist

17:27

when issues of race arose.

17:29

And they would feel like, I'm not sure–

17:33

if the therapist is uncomfortable with talking

17:35

about race, I'm not comfortable going to the therapist for help

17:38

in any respect.

17:39

Now, this led us to– and stop me any time you want,

17:42

this led us to–

17:43

VICTOR YALOM: Well, let me ask you.

17:45

So, did you have a sense, or did you

17:47

get info on what gave them the sense that the therapist wasn't

17:53

comfortable?

17:54

Was it just body language, tone of voice, avoidance?

17:57

DERALD WING SUE: Yes, OK.

17:58

One of them was color-blindness.

18:01

That is that the therapist would emphasize things

18:06

like– when a racial issue would come up–

18:09

the therapist would say something

18:10

that, if I'm going for therapy, Derald,

18:15

I don't see you as Asian American at all.

18:18

You're unique, you're just unique.

18:21

Or that you're very much like me, we're human beings.

18:25

There's only one race, the human race.

18:28

I would feel offended, like many clients of color,

18:34

that an important aspect of my racial cultural identity

18:38

was being overlooked and ignored, and seen as something

18:41

that we should not talk about.

18:42

VICTOR YALOM: And I'm just wondering,

18:42

I imagine if you asked the therapist they might think

18:43

they're trying to connect with the person

18:43

and point out that they don't see that person is differently,

18:44

but it's not having the intended effect.

18:45

DERALD WING SUE: You know, and that

18:45

is one of the issues I have with the conference here.

18:46

The Evolution of Psychotherapy conference.

18:46

VICTOR YALOM: Can we cut that– I just

18:47

want this to be kind of a free-standing interview that's

18:47

not tied to that, so let me restate what I just

18:48

said, and we can go on from there, if that's all right.

18:49

DERALD WING SUE: All right.

18:49

VICTOR YALOM: But you can talk about the field in general.

18:50

So, I'm just wondering if you asked the therapist why they

18:51

might make an intervention like that, or a statement like that,

18:54

they might think that they're trying

18:55

to connect with the client and showed

18:58

that they don't feel different, that they understand

19:01

the client, but it sounds like it

19:03

might have a very different effect on the client.

19:06

DERALD WING SUE: That's precisely–

19:09

one of the things that oftentimes happens

19:12

in counseling and psychotherapy is

19:15

that the therapist, in their attempt to look unbiased,

19:20

that they won't discriminate, they

19:22

tend to downplay the group identities that people have

19:26

by moving to the individual identity or the universal one.

19:31

And I know in terms of intentionally,

19:36

the intention is that I want to connect with similarities,

19:40

or issues that aren't related to possible biases.

19:47

The problem with that is that it communicates

19:51

an invalidation of a client's racial, cultural, ethnic

19:55

identity.

19:56

The second thing is that it communicates

19:58

that the person is reluctant or anxious to touch

20:03

the racial issue that might be important to deal

20:07

with therapeutically.

20:09

And the third thing, that oftentimes is communicated

20:12

with what I call a color-blind approach, or the emphasis

20:16

on sameness or individuality here,

20:21

is that differences are deviant.

20:25

Whether the therapist is aware of it or not,

20:28

the emphasis on sameness is almost an escape, or a belief

20:33

that being the same is good, but being different

20:37

is divisive and causes differences.

20:40

In multicultural counseling and therapy, what we try to do

20:44

is to teach individuals that we have

20:46

all three levels of identity.

20:49

We have a universal level of identity

20:51

that is like what Shakespeare's character Shylock says that,

20:57

when I cut myself, do not I bleed?

20:59

That statement that we do share universal identity.

21:01

There is the individual level of identity

21:01

that Milton Erickson talks about,

21:01

which is that we are all unique, we

21:01

are all different in some way.

21:01

There is a third level of identity– VICTOR YALOM: Do you

21:01

mean Milton or Erik?

21:01

DERALD WING SUE: Erik.

21:02

VICTOR YALOM: OK, let's can we do–

21:02

DERALD WING SUE: No, Milton.

21:02

VICTOR YALOM: Oh, you did mean Milton.

21:02

DERALD WING SUE: Yes, I did mean–

21:02

I mean, if you look at the statement.

21:02

VICTOR YALOM: OK, I just thought– you might think,

21:02

you were at the conference, I just didn't want you–

21:02

DERALD WING SUE: Erik Erikson is a developmental–

21:02

VICTOR YALOM: Yeah I know, I know.

21:02

DERALD WING SUE: He would share that as well, by the way.

21:02

VICTOR YALOM: OK, I just– I didn't want to–

21:03

DERALD WING SUE: Am I touching too much on political issues?

21:03

VICTOR YALOM: No, no, that's fine.

21:03

But it would be helpful if you pause a little

21:03

so we have a chance to interact more,

21:04

I know you're used to lecturing.

21:04

So you were going on the three levels,

21:04

so why don't you go back to the three levels.

21:05

DERALD WING SUE: The second level that I was talking about

21:07

is one of individuality, that we are all

21:09

different in one way or another from individuals.

21:13

The third level that I find therapists–

21:17

and many individuals, not just therapists– find

21:20

very difficult to touch is a group level

21:23

of identity, which includes race, gender,

21:27

sexual orientation.

21:29

Any time those identities or issues are brought up,

21:33

therapists and other individuals tend

21:36

to move to the individual level of identity

21:39

or the universal level of identity.

21:43

And there you have a missed connection.

21:45

And this is what many of the clients that I've talked about,

21:50

racial/ethnic minority clients that I talk to,

21:54

say that they don't feel the individual, the therapist,

21:58

is able and ready to connect with them.

22:01

The just feel kind of this barrier that is between them.

22:06

VICTOR YALOM: The therapist is not

22:07

able to acknowledge the group aspect of it,

22:11

and I would imagine again it's something

22:15

that therapists don't want to be perceived as racist, or–

22:23

DERALD WING SUE: Or that they are.

22:24

See, that's a powerful statement.

22:27

In our work, and this is research

22:31

that we've done with groups of color with white individuals.

22:36

In fact, what we find is that there are four different levels

22:42

of unravelling about why therapists may find

22:46

it difficult to directly address or talk honestly

22:50

about racial issues in counseling and therapy.

22:53

The first level that we're dealing with on a very

22:56

superficial, is the fear by the therapist that whatever they

22:59

say or do will appear racist, even if they aren't.

23:03

The fear is there.

23:04

Now, that constricts their ability

23:06

to verbally interact with the client,

23:09

because they either to dilute the conversation,

23:13

move to a different level, or show constriction.

23:17

Some therapists who have done research on it

23:21

call it rhetorical incoherence.

23:23

That is a therapist is incoherent

23:26

when it comes to talking about these racial/ethnic issues.

23:31

The second level is the most feared level.

23:35

And that is the level of realizing

23:38

that you do have these biases and prejudices, although they

23:43

are outside the level of your conscious awareness.

23:46

And it is difficult for therapists

23:48

to realize that because it conflicts with their image

23:52

as good, moral, decent human beings.

23:55

VICTOR YALOM: That's probably difficult for anyone

23:57

to realize that, yes?

23:59

DERALD WING SUE: Yes, in fact this is something

24:01

why much of my research doesn't deal primarily with therapists

24:05

anymore, it deals with teachers, it

24:08

deals with employers, coworkers.

24:11

It is representative of what I think therapists however

24:16

are going through.

24:17

But that shatters their image of themselves

24:21

as being good, moral, decent individuals.

24:23

And they are.

24:25

It's just that they're out of contact

24:27

with the implicit biases that come out

24:31

unsuspectingly, and in inconvenient times,

24:36

that the person of color, the client of color,

24:40

picks up very easily.

24:42

VICTOR YALOM: Is this what you refer to as microaggressions?

24:46

DERALD WING SUE: Part of it, yes.

24:47

Microaggressions.

24:48

And microaggressions– I'm changing the topic.

24:51

VICTOR YALOM: OK, we'll get back.

24:53

DERALD WING SUE: Microaggressions

24:54

are the everyday indignities, insults, invalidations,

24:58

and put-downs that well-intentioned individuals

25:02

deliver to marginalized groups– like people of color, women,

25:09

LGBTQ individuals– unknowingly.

25:13

It is outside the level of their conscious awareness.

25:17

The microaggressions on the surface

25:20

appear to be innocent inquiries, complements.

25:26

But indeed they contain a meta-communication,

25:29

a hidden message, that invalidates,

25:32

insults an individual.

25:35

And these microaggressions, that can be delivered by anyone,

25:39

especially damaging in therapy, by the therapist,

25:42

can be verbal, nonverbal, or even environmental.

25:48

How their offices is set up is oftentimes invalidating.

25:53

VICTOR YALOM: How could that be?

25:54

DERALD WING SUE: Well, let me give you an example.

25:58

If you're a therapist, and you have pictures

26:03

of all of the major founders of therapy– Sigmund Freud, B. F.

26:10

Skinner, Carl Rogers.

26:14

If you have those on your wall, a person who comes in,

26:19

a client of color who comes in, will see those pictures

26:23

and associate them as primarily white Western European.

26:28

Will this person understand who I

26:30

am in terms of the race and culture that I come from?

26:34

Or if you have a female client and they

26:37

see pictures of just all male therapists on the wall,

26:41

they're going to begin to think about,

26:45

is there sexism that is operative in here?

26:48

Now they may not even be able to verbalize it.

26:51

They would just feel uncomfortable,

26:54

that perhaps there's a disconnect that

26:57

is going on here.

26:59

But that's an environmental– how

27:05

you decorate your office oftentimes communicates

27:07

either receptivity or invitation according to cultural themes,

27:13

as opposed to other groups that might read it.

27:17

This is where the therapist is unintentionally

27:21

delivering microaggressions, and each time

27:25

those microaggressions are delivered

27:28

the credibility of the therapist diminishes.

27:31

VICTOR YALOM: Now, I'm wondering why

27:33

you use the term microaggressions.

27:35

I mean, I could imagine a therapist

27:38

thinking these are the people they studied–

27:40

or I don't know a lot of therapists

27:42

do have pictures of all these on their wall–

27:44

but, to go with your example, I can certainly

27:48

understand that it may not make a client of color

27:52

feel comfortable, and that's something certainly

27:54

to consider.

27:55

But why do you call it a microaggression?

27:58

DERALD WING SUE: Well, microaggressions

28:00

is a term coined by Chester Pierce,

28:06

and African American psychiatrist who

28:10

did studies of TV programs, advertisements,

28:14

that portray people of color and women

28:17

in what he considered to be demeaning issues,

28:22

or the portrayals that were going on.

28:27

And his studies indicated that these portrayals

28:30

had negative impact on the self-esteem and integrity

28:33

of people who were receptive to it.

28:36

Now, advertisers didn't know.

28:38

They thought they were doing something quite well.

28:42

It is also a term used by Maya Angelo.

28:45

She refers to microaggressions as the daily insults,

28:50

the many cuts that are delivered to individuals.

28:56

Any one alone may not be that drastic,

29:01

but taken cumulatively they have major harm.

29:05

And she oftentimes equates this to the little executions

29:12

versus the grand execution of an overt racist that is going on.

29:18

And the term is micro, but the impact is macro.

29:24

Macro in terms of the– it has major pain

29:28

that people experience.

29:30

VICTOR YALOM: All right, well I know

29:30

you've written a whole book on that,

29:32

and that's been in a big area of your work.

29:35

And we could spend a lot of time on that.

29:38

But let's get back to the therapist.

29:44

You had listed points one and two,

29:46

and so let's continue with that.

29:49

DERALD WING SUE: A third point that makes, I think,

29:52

therapists really quite anxious about talking

29:56

about racial, gender, or sexual orientation

30:00

issues is social/political.

30:03

Which many of my colleagues really don't want.

30:07

What I'm talking about this power and privilege.

30:12

We're dealing with the fact that many well intentioned

30:18

therapists do not realize that people of color,

30:22

in relationship to white individuals in this society,

30:26

come from a disadvantaged position– because of a concept

30:30

that is gaining wide usage, white privilege.

30:34

White privilege are the unearned benefits and advantages

30:39

that accrue to groups on the basis of their white skin.

30:44

And so, when the therapist responds

30:46

to an individual that– let's say a black client– that,

30:51

I think if you work hard enough, that you can achieve this goal.

30:56

Because everyone has an equal opportunity in this society.

31:01

It is a microaggressions and that

31:03

is called the myth of meritocracy.

31:06

And I'd like to give the example of what this means

31:12

that deals with the racial realities of white therapists

31:17

and clients of color.

31:20

The example that I like to give that embeds this issue

31:25

of white privilege and power is a statement

31:28

that columnist Molly Ivins in the Austin Times,

31:32

she passed away years ago, wrote about George Bush.

31:36

And she wrote and made this statement–

31:38

George Bush was born on third base

31:41

and believes he hit a triple.

31:48

This is where many CEOs, many people who

31:51

achieved in society who are white,

31:54

tend to have the feeling that they worked hard, sacrificed,

31:59

and achieved what they did.

32:01

And in reality, they did.

32:03

They worked hard.

32:04

But what they don't realize is that women and many people

32:09

of color have worked equally hard,

32:12

but don't even make it to the batter's box.

32:15

That George Bush profited from male privilege,

32:20

economic privilege, and white privilege.

32:23

They're unearned advantages, and that's

32:26

the way our society operates.

32:28

And clients of color, when they come in talking about these

32:33

issues, generally feel put-off if the therapist cannot

32:39

understand what a privilege and power is all about.

32:43

And that many of the statements or assumptions

32:45

that they operate from, operate from privilege and power

32:50

that disempowers clients of color.

32:53

And this is what happens in terms

32:56

of the relationship that occurs.

32:58

VICTOR YALOM: All right, and then the fourth?

33:00

DERALD WING SUE: The fourth one is

33:01

that, if you are a therapist, and you

33:05

realize that you have power and privilege.

33:09

You realize that you are biased, that this is made clearly,

33:14

that you understand.

33:16

It goes to another saying that someone once said,

33:19

in that the ultimate white privilege is the ability

33:23

to acknowledge your privilege and do nothing about it.

33:27

And I'm not inditing all therapists,

33:30

but I'm saying that as a person of color,

33:35

I've got to do something about it.

33:38

I face this every day.

33:40

But that many of my well-intentioned white brothers

33:43

and sisters simply will acknowledge

33:47

that they have advantages, that racism exists,

33:50

but they don't do anything about it.

33:53

And I realize why it is that they

33:55

don't do anything about it, because for them,

33:57

to do something about it means that they will alter

34:01

their relationships with other individuals.

34:04

When they have family members telling racist,

34:07

sexist jokes– it disturbs them, but for them

34:10

to try to bring it up and correct it,

34:13

will isolate them from the family.

34:15

It means a really major change in your life,

34:18

and that's very difficult for many well-intentioned

34:22

individuals to do.

34:29

VICTOR YALOM: All right, so you've certainly

34:31

laid a strong case for the fact that traditional mental health

34:38

treatment wasn't working when you first

34:41

started for minorities.

34:43

And that many therapists, white therapists,

34:48

are uncomfortable in terms of dealing

34:50

with race for a number of different reasons

34:54

and on different levels.

34:55

So, you've been obviously involved

34:59

in training therapists, and advocating

35:04

multicultural competence, as you call it, for therapists.

35:08

So, what does that mean and how do you

35:12

inculcate that in students and therapists?

35:19

DERALD WING SUE: When I do want multicultural training,

35:21

there are four major goals that I believe leads

35:26

to cultural competence.

35:27

VICTOR YALOM: OK, first of all, what

35:29

does that mean, cultural competence?

35:30

DERALD WING SUE: Cultural competence

35:32

is the awareness, knowledge, and skills

35:34

that allow you to work individually and systematically

35:38

in an effective way that is culturally

35:41

congruent with the populations that you're serving.

35:43

VICTOR YALOM: Sure, that's something

35:45

I think we would all strive to.

35:46

DERALD WING SUE: Yes, but how it's interpreted

35:48

is quite different.

35:50

VICTOR YALOM: OK.

35:51

DERALD WING SUE: It's like saying that we all

35:55

stand for equal access and opportunities.

35:58

VICTOR YALOM: Sure.

35:59

DERALD WING SUE: Everyone would agree to that.

36:00

VICTOR YALOM: Absolutely.

36:01

DERALD WING SUE: However, if I say that a part of equal access

36:04

and opportunities is affirmative action– oh, a lot of people

36:09

who agree to the first– when you operationalize it

36:12

in specificity, you get objections of that going on.

36:17

VICTOR YALOM: Sure.

36:17

DERALD WING SUE: But, that to me is a broad definition

36:22

of cultural competence which if you operationalize it,

36:25

has four components.

36:27

The first component is awareness of your own worldview–

36:31

the values, biases, prejudices, and assumptions that you hold.

36:37

And the worldview of the theories

36:39

that you are working from.

36:41

Because those are the theories, and your worldview,

36:44

that is allowing you to determine

36:46

normality, abnormality, healthy, unhealthy functioning.

36:53

I find that very

36:55

Difficult.

36:56

And part of the understanding of worldview

36:58

is not just your cultural understanding.

37:01

It goes back to what I said before– what does it

37:04

mean for you as a white therapist to be white.

37:08

And I find people find it very difficult.

37:12

If you ask me, what does it mean to be Asian American?

37:15

I think I could tell you very quickly.

37:17

If I asked a black American–

37:19

VICTOR YALOM: Well, let me ask you, what does it mean to you?

37:22

DERALD WING SUE: It means collectivism, family values

37:27

that are very close to one another,

37:29

it means a group consensus that occurs.

37:33

But I think the point I'm trying to make here

37:36

is that as a person of color, I wake up in the morning,

37:41

and I look in the mirror, and I know I'm Asian American.

37:46

If I ask you, when you wake up in the morning,

37:49

and look in the mirror, do you say, jeez, I'm white.

37:52

VICTOR YALOM: No, I don't.

37:53

DERALD WING SUE: Yep.

37:54

That's because whiteness is the default standard, is invisible,

37:58

and that invisibility inundates our theories of counseling

38:02

and psychotherapy, and what we define as mental health

38:06

practice.

38:07

And that is what is being imposed on our clients.

38:12

Even the definitions of affect and feelings are different.

38:18

When you as a white person– well, maybe

38:23

I don't want to generalize– but when many whites do something

38:27

wrong, they tend to feel guilty.

38:30

That's not true for Asian Americans.

38:32

If they do something wrong, they may feel guilt,

38:36

but the primary affect is shame.

38:39

Because shame reflects upon the entire family and group,

38:43

while guilt is much more of an individual affect.

38:47

And as a therapist, when you don't recognize it,

38:50

again there is this disconnect that goes on.

38:55

VICTOR YALOM: OK, so let's delve a little further

38:57

into the first point.

39:00

We should have as thorough, as deep an understanding

39:03

of our own world view, and the assumptions that we're

39:07

living by, and the assumptions that we're imposing on others.

39:12

How do you help develop that among therapists?

39:15

Because it seems like a laudable goal, for sure.

39:17

OK?

39:17

DERALD WING SUE: Yes.

39:18

And it's a very difficult thing to do.

39:23

But what you actually do is have to deconstruct

39:26

the theories of counseling and psychotherapy

39:30

as to how they are racially/culturally biased.

39:34

VICTOR YALOM: So what does that mean?

39:36

What does that mean to deconstruct the theories?

39:38

DERALD WING SUE: Well, for example, I gave the example

39:41

about almost all theories of counseling

39:43

and psychotherapy talk about individualism.

39:46

They talk about autonomy, independence, being

39:50

your own person, and that is equated with healthiness.

39:54

VICTOR YALOM: Although, some of the new–

39:56

there's a lot of focus on the attachment

39:58

these days, which is countering, I

40:01

think, some of the extreme individualism.

40:03

DERALD WING SUE: Yes, and those are

40:05

changes that really are occurring

40:08

as a result of, I think, our changing

40:11

perceptions of different group embededness and values that

40:16

are going on.

40:16

How people form relationships.

40:20

But that would be, I think, one of the things

40:23

of deconstruction.

40:24

Insight.

40:26

A cause-effect, or linear orientation,

40:31

that is so typical of a cognitive and behavioral–

40:34

when I was debating Albert Ellis, one of the major things

40:38

that I pointed out to him was that his concept

40:43

of what is rational is culture-bound.

40:48

That in Asian, in African American, and Latino cultures,

40:52

rationality looks quite different from what

40:55

he talked about in our EBT therapy.

41:00

That's what early training needs to look at closely.

41:04

And then the importance is getting people

41:07

to begin to explore their own values of why they consider

41:12

certain behaviors abnormal, and what our normal.

41:18

It's very difficult for people, and I usually

41:23

work from the four basic taboos that they operate from.

41:29

Therapists do not self-disclose their thoughts and feelings.

41:33

That's a taboo that is linked in the ACA and APA standards

41:38

and guidelines of practice.

41:40

VICTOR YALOM: Well certainly there's– that came from

41:42

historically from psychoanalytic work,

41:44

but certainly different schools take different takes on that.

41:48

But I think there certainly is a bias that we keep,

41:52

and we keep guard in that way.

41:53

DERALD WING SUE: Therapists do not

41:55

serve dual role relationships.

41:57

Therapists do not accept gifts from their clients,

42:01

because it might unduly influence.

42:08

These therapeutic taboos are precise qualities

42:16

that many Latinos and African Americans

42:19

consider to be therapeutic means of forming relationships

42:25

that are going on.

42:26

And the rigid application of these,

42:29

and the belief by students going through this,

42:33

has to be deconstructed– unraveled.

42:36

So they can look at it and say, yeah,

42:39

self-disclosure can be done, but it

42:45

has to be done sensitively and for a particular goal

42:49

and reason.

42:50

But the all-encompassing, rigid taboos

42:54

that sometimes I encounter in clinicians, I feel,

42:58

is really quite damaging to individuals.

43:07

VICTOR YALOM: Sure, sure.

43:08

Well, I think that's true– certainly true from the lens

43:11

you're looking through that we're

43:13

talking about from a multicultural perspective.

43:15

And I think it's just true from a therapeutic perspective,

43:18

that anything that's applied rigidly

43:21

without taking a multitude of factors into account

43:24

is going to be anti-therapeutic rather than therapeutic.

43:27

OK, so those are some things.

43:29

What are some other things?

43:30

What are some other ways that you

43:32

help develop that are critical to developing

43:35

multicultural competency?

43:36

DERALD WING SUE: We put them through what

43:39

we call the race lab.

43:41

That involves a great deal of role playing, a great deal

43:48

of keeping journals, to talk about issues

43:52

that they're going through.

43:54

And it is oftentimes very unpleasant and uncomfortable

43:59

when the values and assumptions that are made by our students,

44:03

we confront them with that.

44:05

But that's a need.

44:08

I mean, what I learned in all of my practice–

44:11

cultural competence isn't simply reading a book.

44:15

Acquisition of knowledge– it has

44:18

to encompass experiential reality.

44:21

And that was one of the major limitations of therapists.

44:24

They may mean well.

44:25

They may want to work with clients of color,

44:30

or other socially marginalized individuals,

44:33

but they lack experiential reality.

44:36

They read about the groups, but they have little

44:39

to do with the group.

44:41

They don't socialize with them.

44:42

They don't go to the communities, the public events.

44:46

They have very little– and there

44:48

is this big discrepancy between cognitive knowledge

44:54

and understanding, and affective changes

44:57

and behavioral changes that occur in individuals.

45:02

So part of the thing is that we send them out to communities

45:06

where they interact with people that they've never– we

45:09

send them to African American churches,

45:12

and boy, they are so uncomfortable when

45:15

they go there.

45:16

And they have to engage in response call

45:20

with the preacher and the audience.

45:24

But that is something that is very important for them

45:29

to begin to experience, because they have never experienced,

45:34

nor have they engaged in behaviors

45:37

that allow them to interact in a smooth way

45:40

with people who differ from them significantly.

45:43

VICTOR YALOM: But just hearing about that,

45:45

it makes me a little uncomfortable

45:47

to be thrown into a situation where you're a minority,

45:53

and you're a stranger, and so it seems to me–

45:56

DERALD WING SUE: See, that's another issue

45:58

that I want to say, and that is that I am always

46:05

with people who are different.

46:06

VICTOR YALOM: Right.

46:07

I was thinking that.

46:08

DERALD WING SUE: As a white person,

46:09

you probably have very few times in which you

46:13

are in an all black group, an all Asian group, or all Latino

46:18

or Native American group.

46:20

But as a person of color, I have no choice in that.

46:24

If I want to make it in this world,

46:27

I have to interact with people who differ from me.

46:30

And that's part of white privilege.

46:32

White privilege is your ability to decide

46:35

whether you want or don't want to have interactions

46:38

with certain groups.

46:40

And that is what prevents us from really developing

46:45

cultural competence that has meaning

46:48

on an emotive and behavioral level.

46:51

Having it just on the cognitive level

46:54

will not make you and effective multicultural therapist.

46:57

VICTOR YALOM: I could see there would

46:59

be a lot of resistance to people going.

47:02

Who wants to put themselves in an uncomfortable situation?

47:05

I hear you're saying that that's not a choice for you, but–

47:09

DERALD WING SUE: But we help them too.

47:11

Victor, we just don't say OK, go out on your own.

47:15

We have usually a liaison, or someone

47:20

in the church who is willing to.

47:22

One of the worst things that you can do

47:25

is to send someone alone, without the appropriate

47:28

support, into a situation.

47:30

And then they can come back and process their thoughts

47:34

and feelings and fears that are going on,

47:37

and for us to begin to talk about it.

47:38

VICTOR YALOM: That sounds a little better.

47:40

DERALD WING SUE: No, we don't drop them.

47:42

VICTOR YALOM: OK.

47:43

But it seems to me the value is A, having that contact,

47:49

I mean on two levels that at least strikes me.

47:51

Having that contact so you get to know

47:54

a different cultural group in a different way.

47:57

And that may be more cognitive and experiential.

48:00

And then B, having that personal experience that you're saying,

48:04

you have every day of your life.

48:08

So, what else do you do?

48:10

What else do you do?

48:11

DERALD WING SUE: I tell my– you know, we do– that's enough.

48:16

Because it brings out so much feelings and processing

48:20

that goes on, plus the fact of role playing–

48:24

working with clients of color, with women, with LGBT.

48:30

We have certain scripted issues that we

48:34

want to present that may have racial topics.

48:37

For example, we may have a black student volunteer

48:43

role play a black client with a white counselor therapist

48:49

trainee.

48:50

And the issue might be the issue of trust/ mistrust.

48:54

And one of the common things that

48:57

happens in multicultural therapy is that clients of color

49:02

will come in, especially if they have a racial concern,

49:06

with the thought of– what makes you any different from all

49:11

the other well-intentioned white neighbors, white teachers who

49:16

said they wanted to help me, but indeed operated

49:20

from unconscious biases?

49:23

What makes you the therapist any different from all the others

49:28

out there.

49:29

The second challenge that they are likely to do,

49:33

to give to you, is to challenge your credibility

49:39

as to how open and honest are you about your own biases.

49:45

And they may make statements as their talking to you–

49:49

their presenting a racial issue, was that,

49:53

can you possibly understand the black experience?

49:57

And watch your reactions to that.

50:01

These are challenges that occur.

50:03

VICTOR YALOM: And these are things you role play?

50:05

DERALD WING SUE: Yes, yes.

50:07

But they do come up in setting.

50:10

That's why we scripted them from therapeutic– actually,

50:14

one of them might be if a black client is involved

50:20

in an interracial relationship, they

50:23

may come in and in some way ask you,

50:28

how do you feel about interracial relationships?

50:32

And we will watch the nonverbal and the verbal behaviors.

50:37

And oftentimes we'll find trainees

50:41

saying that, well, I think it's fine.

50:46

And what is happening here is that the verbal statement

50:50

is contradicted by the non verbal.

50:53

And we're videotaping all of these role plays,

50:56

because we come back and look at it, now later,

50:59

to explore the meaning of it.

51:02

We also give knowledge and understanding to the trainees

51:08

that study after study suggests that people of color and women

51:15

are better readers of nonverbal cues

51:18

than their white male counterparts.

51:21

I mean, there's a lot of reasons for why that is true.

51:24

It's because there's a common belief among people of color

51:30

that– don't listen to what Dr. Smith says, but how he says it.

51:36

Behind that statement is a belief

51:39

that the nonverbals are more accurate

51:44

predictors of where that person is coming from.

51:47

So when you respond by saying, oh, interracial relationships

51:53

are fine with me, you are sending off also nonverbal cues

51:58

that may only reinforce the thought of a client of color,

52:02

that isn't this typical of white folks–

52:05

say one thing, mean another.

52:08

Now, these are really uncomfortable role plays

52:12

that occur within individuals, because how

52:17

you meet the challenge will either–

52:19

and we tell them– with either enhance or negate

52:22

your credibility with the client that is coming before you.

52:27

But more importantly, it forces you in our processing,

52:32

as we watch the videotape tape, to go

52:34

on your own assumptions, values, and potential biases.

52:41

And it becomes very uncomfortable for individuals

52:44

to go through that type of training.

52:46

VICTOR YALOM: All right, it's uncomfortable– so

52:48

is this in the context of a one semester

52:51

course, a yearlong course?

52:53

DERALD WING SUE: One semester.

52:54

But our program at Teacher's College at Columbia University

52:58

is consistent.

52:59

It consists of– for a master's level students,

53:05

they go through two years.

53:07

Almost all our courses are infused with multiculturalism.

53:13

When you take a course on family dynamics, or family process,

53:18

we talked about the Asian American family,

53:22

the black family.

53:24

I mean those sort of a part and parcel,

53:26

so it's not simply courses that require

53:31

multicultural counseling.

53:33

They are part of assessment, part of group therapy,

53:37

and that's what we do in terms of infusing it

53:41

into the education.

53:43

VICTOR YALOM: Yeah.

53:43

So, let's get back to the race lab that you do.

53:47

That's what you call the class?

53:48

All right, so I've certainly heard–

53:51

I've talked to lots of colleagues and students,

53:53

and I've certainly heard a wide variety of experiences

53:57

that people have had in whatever the class is

54:00

called at that particular school.

54:02

And I've certainly– I've heard some people have positive

54:04

experiences, and as you say its uncomfortable,

54:07

so I've certainly heard that there's uncomfortable–

54:09

But I've also heard, a number of, frankly horror stories,

54:13

where the class is just– self-destructs .

54:17

Bad stuff happens.

54:19

I heard a case where an LBGT student

54:23

received a death threat.

54:25

I mean, that wounds were opened up that never repaired

54:30

throughout the course of a four or five year Ph.D. program,

54:35

so–

54:36

DERALD WING SUE: Yeah, I think that those reports came

54:42

from early courses in terms of the race lab,

54:46

and I do agree that there were major issues depending

54:50

upon the instructor.

54:52

Who taught it really becomes, when you teach–

54:56

VICTOR YALOM: And some of these are current– recent.

54:58

DERALD WING SUE: Well, then I don't know.

55:02

What you need to do is balance the challenges

55:07

with the supports that students get.

55:11

But apart from that, I think when

55:14

you deal with your own biases, it's not only uncomfortable,

55:19

it can be quite painful.

55:20

And in today's conversation that I, conversation hour,

55:26

there were a number of people who

55:29

up and talked about– faculty of color– who came up

55:35

and talked about the fact that they have difficulties teaching

55:39

a diversity, multicultural course based upon the reactions

55:44

that students would have and the unsupportive reactions

55:49

that administrators did.

55:51

In fact, I think what I tried to confer

55:54

with them is that when you push buttons in people,

55:57

you do open up wounds that they have.

56:02

It's not pretty or exciting, oftentimes,

56:04

to look at your biases.

56:07

But the other end of it is that I

56:11

have some thoughts about the fact

56:15

that when you deal with implicit bias, it is painful.

56:22

And all of our– the studies that I shared with the group

56:27

today, indicates that multicultural training

56:31

is very good at enhancing multicultural competence

56:38

and diminishing explicit bias, bias that we're aware of

56:43

and know of.

56:44

Multicultural training seems to have

56:47

minimal impact on implicit bias.

56:51

And the issue now becomes– what type

56:54

of training taps implicit bias?

56:57

This is among the first studies that

57:00

came out in the past few years about the success

57:04

of multicultural training–

57:06

VICTOR YALOM: So just quickly, I don't

57:07

want to get too much into detail,

57:09

but how is that assessed?

57:12

How do you test whether it's effective?

57:14

DERALD WING SUE: Well, they use what

57:16

we call the implicit attitude test.

57:19

This is– you probably heard about it–

57:22

it's on the Harvard website.

57:25

And what they do is they measure the quickness of response

57:31

of measuring positive words with faces of blacks,

57:36

Asian, women, white individuals.

57:38

It is very much patterned after the work

57:42

by Joseph Correll who talked about the quickness by which

57:49

police officers in simulated games

57:52

fire at what they consider to be a white suspect

57:56

or a black suspect.

57:58

VICTOR YALOM: So it's a test that's

58:00

gathering instant reactions that can't

58:02

be consciously manipulated?

58:04

DERALD WING SUE: Yes.

58:05

And so, that's different from taking– you know,

58:10

do you believe blacks are unintelligent, prone to crime.

58:13

You'll say no and no.

58:15

And, the people who take the IAT truly

58:20

believe that they are unbiased, but when

58:22

they take this test about 85% come out

58:27

revealing that they have these implicit biases.

58:31

Don't ask me about the other 15%.

58:35

And they've also developed an IAT for children,

58:39

going as low as five, six, 10, 11.

58:43

And they measure both implicit/explicit bias,

58:47

and find that as you get from three to four, to 10 and 11,

58:53

both implicit and explicit bias increases.

58:59

From about 10, 11 to adulthood, explicit bias

59:03

among white individuals plummets consistently.

59:08

Implicit bias does not change.

59:11

VICTOR YALOM: So you're saying implicit bias

59:13

is not effected by these courses.

59:16

DERALD WING SUE: Yes.

59:17

And all the time, I've been operating under the fact

59:20

that we have been doing, and tapping it, with what we have.

59:24

And now I think the great challenge

59:27

is how do we address the implicit biases that people

59:32

have.

59:33

And, I honestly think that it may not be possible to do.

59:39

And that the remediation that we currently

59:44

have set up in training may not tap that.

59:48

So what it means to me, is prevention.

59:51

And if we take a preventive approach,

59:54

then I look at the pre-K through 12 group.

59:58

That, if you truly had a multicultural, anti-racism,

01:00:02

anti sexism curriculum from pre-K through 12,

01:00:07

the people who go through the program

01:00:10

won't have accumulated the biases that you and I have now.

01:00:15

And this is something, by the way,

01:00:17

I want to make clear– that people of color

01:00:21

also have prejudices and biases because we

01:00:24

all been the product of the social conditioning.

01:00:27

So that when you talk about multicultural counseling

01:00:29

and therapy, you're not just talking

01:00:31

about black/white, Asian/white, Latino/white.

01:00:35

You're talking about Asian/black, black/Latino,

01:00:38

Latino/white, white/Native American,

01:00:40

all of these combinations.

01:00:41

VICTOR YALOM: I read that you wrote in the forward

01:00:43

to your book, I believe, that when you first–

01:00:45

the first edition came out in the 1980s, something like that?

01:00:49

DERALD WING SUE: 1980.

01:00:50

VICTOR YALOM: Yeah.

01:00:51

DERALD WING SUE: A long time ago.

01:00:53

VICTOR YALOM: You got a lot of hostile reaction,

01:00:55

including that you were a white basher.

01:00:58

DERALD WING SUE: Yes, well actually, it was stronger.

01:01:01

I was a racist, but of a different color.

01:01:06

People would call and write about this.

01:01:09

But I guess you go through a period of evolution

01:01:17

where I no longer see white individuals

01:01:22

as primarily oppressors.

01:01:24

I see them as equally victimized in a racist society.

01:01:29

That my victimization is different from yours,

01:01:32

but we've been all culturally conditioned

01:01:35

to have certain biases and images about one another,

01:01:40

and I realize now that none of us

01:01:43

came into this world wanting to be a bigot.

01:01:47

I didn't, at birth, wanted to be a racist,

01:01:50

or– we took this on through a flawed system

01:01:54

of social conditioning that occurs through the mass media,

01:01:58

through education, significant others and institutions.

01:02:02

VICTOR YALOM: And it seems to occur universally.

01:02:04

I mean, wars are not a new thing.

01:02:09

DERALD WING SUE: Yes.

01:02:10

VICTOR YALOM: But, I certainly– it's

01:02:15

hard to argue with statistics that are widely available

01:02:19

and you've quoted many places, that white males do

01:02:22

hold a position of privilege in this society

01:02:25

and hold positions of power.

01:02:29

But in your textbook, you have chapters

01:02:33

on counseling Latinos, counseling African American,

01:02:36

counseling Muslims, counseling LGBT, counseling and women.

01:02:40

You don't have a counselor on counseling men, or counseling

01:02:43

white men.

01:02:44

DERALD WING SUE: Well, is an interesting statement

01:02:47

that you're making, because isn't that what psychology is?

01:02:52

VICTOR YALOM: Well–

01:02:53

DERALD WING SUE: Yes, it is.

01:02:54

I mean, Robert Guthrie–

01:02:55

VICTOR YALOM: Well, but–

01:02:56

DERALD WING SUE: Let me finish.

01:02:57

Robert Guthrie, an African American psychologist,

01:03:00

wrote a book that took off.

01:03:02

That was called Even the Rat was White.

01:03:06

What he was saying is that history of psychology,

01:03:09

all the values, come from a white Western European

01:03:15

perspective.

01:03:16

And it was his statement that this, to me,

01:03:20

is the invisibility of whiteness.

01:03:24

I remember when I and my colleague at the California

01:03:28

State University at Hayward advocated

01:03:32

for a course on multicultural counseling or counseling

01:03:36

of Asian Americans and blacks– my white colleagues,

01:03:40

well-intentioned, would say that, well then we

01:03:42

should have a course on counseling whites.

01:03:45

And my answer to them, a response

01:03:48

was that we do already.

01:03:50

All of psychology is based upon that.

01:03:53

VICTOR YALOM: No.

01:03:53

DERALD WING SUE: You don't agree with me.

01:03:55

VICTOR YALOM: Well, your point's well taken, but no.

01:03:57

Well, I guess the only thing I'd counter

01:03:59

is that I think a lot of the history of psych care,

01:04:03

and psychotherapy, was male therapists

01:04:07

or analysts, female clients, and there

01:04:10

are people like Ron Levant who has written

01:04:13

a lot about a lot of men feel shamed in therapy.

01:04:18

That we're socialized, I think as men– white men,

01:04:23

and I'm sure Asian men in a different way– that

01:04:28

getting in touch with our feelings

01:04:30

is not the thing to do.

01:04:33

Studies have shown at the age of nine or 10–

01:04:37

up to the age of nine or 10– I think boys and girls cry

01:04:40

equally, and then boys learn quickly

01:04:44

that that's not the thing to do.

01:04:45

And I think there are specific things that, for men

01:04:50

that don't easily access their feelings.

01:04:53

DERALD WING SUE: I agree, and Ron Levant's work is very good.

01:04:57

It might make you feel better that in our most

01:05:01

recent book on case studies and multicultural counseling

01:05:04

and therapy, we include white men in terms

01:05:10

of the special issues that they encounter.

01:05:13

And that is important.

01:05:16

I'm not saying it's not important,

01:05:18

but I'm saying that overall psychology is very white.

01:05:24

And the visibility of whiteness–

01:05:30

see, I oftentimes say the goal of counseling and therapy,

01:05:33

the goal of our society and actually beyond that,

01:05:36

is to make the invisible visible.

01:05:39

And whiteness is an invisible default standard

01:05:45

that really comes out in all aspects detrimentally.

01:05:49

For example, in the Georgia Zimmerman verdict.

01:05:54

What was happening, if you recall during that verdict,

01:05:59

the Judge said to everyone that you cannot use the word racial

01:06:06

profiling.

01:06:07

You can use the word profiling, but not racial.

01:06:11

Both the defense and the prosecution

01:06:14

said that race was not an issue.

01:06:17

After the verdict of not guilty, when Juror B37, a white woman

01:06:24

came out, she said during the jury deliberations race

01:06:29

never entered the dialogue or discussion.

01:06:33

Now, what I would say is race always matters.

01:06:38

By eliminating African American life experiences,

01:06:45

by saying that's no longer– the default standard was white.

01:06:50

And whiteness entered into the determination

01:06:54

of what could or could not be the outcome.

01:06:58

It's primarily like when a Latino student is

01:07:05

told by a white teacher, that I don't care if you come in

01:07:10

and talk about these holidays and art,

01:07:14

but I want you to leave your cultural baggage

01:07:16

outside of the classroom.

01:07:19

Well, if I was to say to the teacher,

01:07:22

I don't care that you're the teacher in the class here,

01:07:25

but I want you to leave your white cultural baggage outside,

01:07:29

the person wouldn't know how to teach.

01:07:31

It wouldn't make sense to them.

01:07:33

Because teaching– the curriculum,

01:07:36

how you ask questions, how you lecture,

01:07:40

are Western European methods of education

01:07:44

that differs considerably from other groups.

01:07:49

Among African Americans, you don't sit passively.

01:07:52

You enter a response call.

01:07:55

If you go to the African American churches,

01:07:58

if the preacher gets up and makes a statement,

01:08:01

the congregation says right on, say it again.

01:08:06

Supposing you are white teacher and you have a black student

01:08:09

in your classroom, and you're talking about President Obama,

01:08:13

and the student says right on teacher.

01:08:15

What would the teacher do?

01:08:17

Johnny, you sit down and be quiet.

01:08:19

I mean, this is the imposition that occurs.

01:08:22

And this is where the invisibility

01:08:25

happens in terms of counseling and psychotherapy

01:08:29

standards of normality, abnormality.

01:08:31

Culture is there, but it's white Western European culture.

01:08:32

VICTOR YALOM: Yeah, OK.

01:08:32

So let's get into therapy room, and assuming one

01:08:33

has achieved some cultural competence.

01:08:33

I'm sure it's not an off/on switch,

01:08:33

you have it or you don't.

01:08:34

INTERVIEWER 2: Victor, can we pause for one second.

01:08:34

VICTOR YALOM: Yes.

01:08:35

INTERVIEWER 2: [INAUDIBLE]

01:08:35

DERALD WING SUE: Oh my goodness.

01:08:35

VICTOR YALOM: What time is it?

01:08:35

DERALD WING SUE: Oh, it's nearly 5:30.

01:08:35

VICTOR YALOM: 5:30.

01:08:36

Do you need to stop?

01:08:36

DERALD WING SUE: We've been going.

01:08:36

I'm sorry, I'm talking so long, it's just so.

01:08:37

VICTOR YALOM: I want to–

01:08:37

INTERVIEWER 3: Thank you.

01:08:37

VICTOR YALOM: Thank you for coming.

01:08:37

What time you need to stop by?

01:08:38

DERALD WING SUE: Well, I've got– I'd like to,

01:08:38

can we do 15 more minutes?

01:08:39

VICTOR YALOM: Yes.

01:08:39

OK.

01:08:39

Yeah, I'd like to get into–

01:08:39

DERALD WING SUE: You know, I'm a hard person to interview.

01:08:40

VICTOR YALOM: You are, you're a little hard.

01:08:40

Pause a little more.

01:08:41

Give a few more pauses so I can get it.

01:08:41

DERALD WING SUE: I can't, it's just, you know–

01:08:42

VICTOR YALOM: OK, so–

01:08:42

DERALD WING SUE: You've watched my lectures.

01:08:42

VICTOR YALOM: I know.

01:08:42

DERALD WING SUE: I get on a role.

01:08:43

VICTOR YALOM: You're passionate.

01:08:43

So in the time we have left, I'd like

01:08:44

to talk a little bit about what to do in the therapy room.

01:08:45

So, let me guide this a little so we

01:08:45

get to where we want, and just do it every five minutes.

01:08:46

Five, 10, 15, stop.

01:08:46

All right.

01:08:47

Does that sound good?

01:08:47

INTERVIEWER 2: Yep.

01:08:47

VICTOR YALOM: Ready to go?

01:08:47

INTERVIEWER 2: Yep.

01:08:47

VICTOR YALOM: Yeah.

01:08:47

So let's take a look at what you would advocate in the therapy

01:08:50

or counseling room, assuming someone has achieved some level

01:08:54

of cultural competence– and I'm sure it's a gradation,

01:08:57

you don't either have it or don't.

01:08:59

A typical example, you're a white therapist

01:09:06

and you have a minority client, African American,

01:09:09

Asian American, et cetera.

01:09:11

What do you do?

01:09:13

Because I've heard many years ago

01:09:16

advice that you should always bring it up.

01:09:19

You should always say at some point

01:09:21

early on in therapy, first session,

01:09:26

how does it feel for you to be in the room

01:09:28

with me, a white counselor.

01:09:29

And I've heard therapists say that doesn't always go so well.

01:09:34

And then there are folks like Kenneth Hardy,

01:09:38

African American psychologist, who

01:09:40

says that, that can really put the client on the spot.

01:09:44

And instead he advocates maybe having a more invitation,

01:09:49

by talking about his own experience,

01:09:52

and signaling to the client indirectly,

01:09:56

this is something I'm comfortable to talk about.

01:09:59

What are your thoughts about that?

01:10:00

DERALD WING SUE: First of all, we are making an assumption

01:10:03

that the trainee is aware of themselves

01:10:07

as a racial/cultural being.

01:10:08

Because no matter what advice I give,

01:10:11

or suggestions, if the person isn't

01:10:14

aware of their racial/cultural being,

01:10:18

they are not going to be– it's not

01:10:21

simply a technique oriented situation.

01:10:24

VICTOR YALOM: OK, that's good to hear.

01:10:25

DERALD WING SUE: Yeah, and the other thing

01:10:27

that is really quite important is that whether you bring

01:10:32

the issue of race up or not, and when you do it,

01:10:36

depends on two situations.

01:10:39

One, are you aware that race may be an issue.

01:10:43

Two, are you comfortable in talking about race.

01:10:47

Because if you're aware but not comfortable,

01:10:49

it's not going to go well.

01:10:52

My feeling is that because race is always an issue,

01:10:56

it's a clinical decision about when you– whether you bring it

01:11:00

up initially, or wait for when, as Ken Hardy

01:11:04

says, that it's more appropriate that the client invite you.

01:11:09

To no bring race up if indeed it is something

01:11:13

that the client is not focusing in upon,

01:11:15

because it's far outside of what– it

01:11:19

may seem totally inappropriate.

01:11:21

But when you sense that the person is involved

01:11:25

in thinking about– can Dr. Yalom really

01:11:30

understand what I'm going through?

01:11:32

When you begin to experience that, it may be a possible–

01:11:37

and probably recommended– that you bring up the issue of race.

01:11:43

And that might be acknowledging that you're

01:11:47

trying to understand his experience

01:11:50

from a white perspective.

01:11:52

That you're comfortable about talking about that issue.

01:11:56

But when you do it, it is really a clinical decision

01:11:59

in terms of the timing and appropriateness of it.

01:12:02

VICTOR YALOM: All right.

01:12:03

So, it's good to hear that it's not something

01:12:05

automatic, or a technique.

01:12:06

Because I think, whether it's a racial issue

01:12:09

or some empirically validated treatment of some other kind,

01:12:14

you always want to exercise a clinical judgement.

01:12:17

DERALD WING SUE: And the second thing I think I would say

01:12:19

is that the culturally competent therapist is a therapist who

01:12:26

is able to engage in a number of different helping behaviors,

01:12:32

and comfortable with doing that what.

01:12:35

What is that– the skills training.

01:12:39

You have the Ivy– Alan Ivy's microtraining dynamic

01:12:46

divides up helping skills into attending and influencing

01:12:50

skills.

01:12:51

Attending skills are what you think

01:12:55

about Carl Rogers and person-centered counseling.

01:12:58

It's uh huh, please go on.

01:13:00

Head nods, appropriate eye contact.

01:13:04

But the attending skills are not talk to our trainees very well.

01:13:09

Now, attending skills are skills like giving

01:13:12

advice and suggestions.

01:13:15

Self-disclosing.

01:13:17

Expression of content, expression of feelings.

01:13:21

These are generally considered to be taboo types of behaviors

01:13:27

that beginning trainees avoid.

01:13:29

And what we try to do is expand their repertoire,

01:13:33

because they are very good at paraphrasing, reflecting

01:13:36

feelings, but they are not good at expressing content,

01:13:42

summarizing, doing other types of behaviors.

01:13:47

And if you operate predominantly on the attending skills, of how

01:13:53

you relate to a client, many African American clients

01:13:58

would feel that that's unhelpful to me.

01:14:02

I want advice and suggestions.

01:14:04

I want to know where you're coming from.

01:14:07

I want to know your feelings.

01:14:08

Because that's a measure to them of authenticity.

01:14:12

That you're willing to engage in the relationship,

01:14:16

to establish this working relationship.

01:14:21

And what we find, is that– I give this example

01:14:25

to students about the capital to and the ant.

01:14:28

Because the caterpillar is going up a leaf,

01:14:32

climbing up the leaf.

01:14:34

All the legs are working in unison.

01:14:37

And the ant in admiration, and astounded,

01:14:41

walks up to the caterpillar and says

01:14:44

how do you do that without tripping?

01:14:46

Well the caterpillar thought about it and tripped.

01:14:50

That's what is happening with many of our trainees,

01:14:54

that they actually become less competent and capable

01:14:57

therapists as they go through the training

01:15:00

because they become so self-aware of what they're

01:15:03

doing that the new behaviors aren't

01:15:07

natural and authentic to them.

01:15:09

And so that's what we work on, for them

01:15:12

to become much more natural and authentic.

01:15:14

VICTOR YALOM: Yeah, well I think that may

01:15:16

be the case with many skills you learn.

01:15:18

Whether it's playing piano, or tennis.

01:15:20

If you're that early stage, you become self-conscious,

01:15:23

and as you move towards mastery, you

01:15:27

drop those voices in your head telling you what to do.

01:15:30

DERALD WING SUE: And there are times

01:15:32

when you can't be everything to everyone.

01:15:33

Where you don't have those skills.

01:15:37

And the next best thing that we tell our students

01:15:40

is for you to be able to anticipate

01:15:43

your social impact on the client.

01:15:46

We know that clients have different beliefs about how

01:15:52

to deal with the things, and if the counselor or therapist

01:15:56

is unable to do it, this rupture in their relationship

01:16:03

may happen.

01:16:04

But a therapist who is aware that is

01:16:07

going to have a negative impact upon the client

01:16:11

can take steps to soften the blow.

01:16:15

That may–

01:16:16

VICTOR YALOM: For example?

01:16:17

DERALD WING SUE: Well, OK.

01:16:18

A long time ago I worked with counseling

01:16:25

with Asian Americans, and one of my– at the clinic,

01:16:30

at Cal State Hayward– we had a Filipino client come in

01:16:36

to work with a white female therapist trainee.

01:16:41

And we have things like observation rooms

01:16:45

where we observe what's going on.

01:16:47

He came in to the session, it was not a student,

01:16:50

he was in the public coming in for–

01:16:53

and he came in with a issue that he presented,

01:16:59

kept about the relationship with his recent marriage

01:17:04

with his wife.

01:17:05

But he presented the issue in a roundabout way

01:17:09

and the therapist was limited.

01:17:13

My father was really good at subtlety,

01:17:16

at talking about something as if he's not talking about it.

01:17:20

And the Filipino client really was expecting the therapist

01:17:25

to not talk about it directly, but to indirectly

01:17:29

touch upon those topics.

01:17:31

But she didn't that subtle–

01:17:33

VICTOR YALOM: That's a difficult–yeah,

01:17:35

that's a difficult skill.

01:17:36

DERALD WING SUE: And so, as the session went on,

01:17:39

it became clear to us– the group

01:17:41

that was observing– that the Filipino client had

01:17:45

an issue with sexual relationships.

01:17:49

He didn't want to say it.

01:17:50

It was too shameful and embarrassing.

01:17:53

And as the session went on, the anxiety increased,

01:17:57

and we all knew that this client was not going to come back.

01:18:01

Until the female therapist took a risk.

01:18:05

She said to him, I know this will sound very Western to you,

01:18:10

and I don't mean to be that direct,

01:18:13

but I really don't know how to address this issue.

01:18:17

I apologize, please forgive me, but are you

01:18:20

having sexual difficulties with your wife?

01:18:24

And the Filipino male sat bolt up, upright.

01:18:27

But rather than ending the session,

01:18:30

he continued to work with her.

01:18:33

And our analysis was that– the truth of the matter

01:18:38

was that he found out on his wedding night

01:18:41

that his recent wife was not a virgin.

01:18:45

Now, many of us would say, big deal now about it.

01:18:48

But for him, the cultural dictate

01:18:51

was that his family was betrayed by him not knowing.

01:18:59

And the legitimate thing to do was to divorce

01:19:02

or have the marriage annulled.

01:19:04

And he didn't want to do, that because he loved his wife.

01:19:09

And so this was what he wanted to talk about.

01:19:13

But what we found out was that the therapist

01:19:17

anticipated her social impact.

01:19:20

Indicated that this was a weakness of her own,

01:19:24

not anything due to him, and said I really

01:19:27

want to work with you, I apologize if this is going–

01:19:31

That to me was an indication, not only

01:19:34

that you have to have the skills,

01:19:35

but if you don't and you're up against– being

01:19:39

able to anticipate your social impact,

01:19:43

and I find that most trainees have very little idea

01:19:47

about the social impact they have on people.

01:19:50

And videotaping is really powerful

01:19:53

to give them insights into how they come across to others.

01:19:57

VICTOR YALOM: All right.

01:19:58

So, we've been talking a lot about training.

01:20:00

Just before we wind up, if you– if

01:20:09

someone gets some level of real mastery

01:20:12

of multicultural competence, what does that look like.

01:20:18

What is master multicultural therapist look like?

01:20:22

DERALD WING SUE: I think that the four things that I've said.

01:20:27

Self-awareness of yourself as a racial/cultural being.

01:20:31

Awareness and understanding of the groups

01:20:34

that you hope to work with, and understand

01:20:37

that you understand their worldview.

01:20:39

Not that it's particularly that you buy into it,

01:20:42

but you understand it.

01:20:43

The ability to engage in a wide range of culturally appropriate

01:20:49

intervention strategies that involve not only culture

01:20:54

specific, the cultural universal helping strategies.

01:20:59

And the fourth thing that we haven't talked about, really,

01:21:02

is the systemic understanding about how systems affect

01:21:07

the client, and how your role as a helping

01:21:10

professional, since you are employed by an organization

01:21:14

or institution, or working in private practice, how

01:21:20

you are influenced by that.

01:21:22

Those are things that I look for.

01:21:25

And then the other thing I would say

01:21:27

is that multicultural or cultural competence is not

01:21:30

an end state.

01:21:32

It is a constant, continual journey that people are making.

01:21:37

I'm still learning things from my LGBTQ brothers and sisters

01:21:44

that I really– that amazes me sometimes in terms

01:21:49

of going up and talking, they indicate to me

01:21:52

that I have a distorted view of what might be going on.

01:21:57

And I always like to say that we will all commit blunders.

01:22:02

We will all commit racial, gender, sexual orientation

01:22:06

blunders.

01:22:07

The importance is how you recover, not how you cover up.

01:22:11

And I find beginning therapists, and even established

01:22:15

therapists, when they commit a blunder,

01:22:17

get defensive and cover up rather than– what

01:22:21

did I just do or say that came across that way?

01:22:25

And those are things that I look for in terms

01:22:28

of cultural competence.

01:22:29

VICTOR YALOM: Yeah, well that sounds

01:22:31

very freeing in some sense.

01:22:34

Because I think, I think judging from myself and from others,

01:22:42

there's a fear around it.

01:22:43

There's a fear, certainly among white therapists,

01:22:47

that we're going to be perceived as not understanding,

01:22:51

as racist, as narrow minded, as oppressive.

01:22:56

And so, this idea that we're all learning.

01:23:04

We're going to make mistakes.

01:23:05

And to have that attitude of curiosity

01:23:10

and questioning sounds like a healthy attitude

01:23:14

to carry on with.

01:23:15

DERALD WING SUE: It is, it is.

01:23:16

VICTOR YALOM: Good.

01:23:17

And you've certainly modeled that through your career.

01:23:22

And through your writings, being quite open with your journey,

01:23:29

because you've had a journey, quite a journey

01:23:32

yourself in coming to where you are, and had

01:23:36

a major impact on our field and on the training of our field.

01:23:40

So, I thank you.

01:23:41

DERALD WING SUE: Thank you also.

01:23:42

VICTOR YALOM: I thank you for your contribution

01:23:44

and I thank you for taking the time

01:23:47

to tell me where you are at your state in this journey.

01:23:53

DERALD WING SUE: Ok, thank you

01:23:54

VICTOR YALOM: All right.

01:23:54

DERALD WING SUE: All right.

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