Racial Ethical Cultural and Linguistic Issues - Research Paper Example

 Racial Ethical Cultural and Linguistic Issues Abstract The paper looks at the ethical client patient relationship in licensed professional counselors. The beneficial influence of the society, and family members have diminished over the years and many individuals facing psychological problems now rely on professionally qualified outsiders. In such instance, issues such as linguistics, caste, color, religion, and disclosure of information can become problematic in the relationship. The paper argues that such professionally qualified persons such should take into consideration all the above factors in order to provide effective counseling. In other words, the counselor should not have a racist or discriminatory attitude. Moreover, an understanding of the diversity of the client with regard to the counselor will also help in making the therapy more effective. Introduction: It could be said that psychological issues have been in existence in all human societies. The normal practice is to obtain some form of counseling or even treatment. In the past, when societies and its members lived closely together, this was done by family elders or other persons usually referred to as witch doctors. They were usually of the same culture, color, and caste of the person being counseled or treated. But as societies developed, and the field of psychology was recognized as a science, the relationship began to change. Families were moving out to cities making them nuclear in nature. This resulted in the concept of professional counselors and psychologists/psychiatrists. Very often the counselor and the counseled will be complete strangers. In a diverse society (like in the United States), the two could belong to a different caste, color or religion. Their culture, social beliefs and norms will be entirely different in such cases (Houser, Wilczenski & Ham, 2006, 110). It is possible that the concept of ethics, which is so important in a relationships of this sort maybe violated knowingly or unknowingly by the counselor. This paper looks at the issue of ethics on the part of licensed professional counselors (LPC). In the process, it will cover various aspects such as racism, ethnicity, culture and linguistics. It will also review the importance of the LPC being knowledgeable of the above aspects in order to provide effective counseling, failing which an ethical violation may arise. Definitions: of the following terms will be given before moving on to the body of the paper. Racism: Racism can be defined as “the belief that people's qualities are influenced by their race and that the members of other races are not as good as the members of your own, or the resulting unfair treatment of members of other races” (Cambridge Dictionary, 2010). According to another definition given by Princeton University, racism to be termed as such requires two aspects, one is the feeling of being superior by belonging to a particular race and the other being abusive behavior towards members of another race. It can be assumed that this behavior can include words, actions or gestures, and physical intimidation or violence. Both the definitions stress on superiority and behavior and hence the paper will take this factor into consideration. Overt racism: The term overt means open and not hidden. Hence overt racism can be easily identified. Institutional racism: “It denotes those patterns, procedures, practices and that operate within social institutions so as to consistently penalize, disadvantage and exploit individuals who are members of a non-white racial ethnic groups” (Better, 2008, 11).. So random acts of racism can only be considered to be those perpetuated by individuals in an organization. Ethnicity: “Ethnicity involves a consciousness of difference, which, to varying degrees, entails the reproduction and transformation of basic classificatory distinction between groups of people who perceive themselves to be in some respects culturally distinct” (Jones, 1997, 84). Hence ethnic racialism (and lack of ethics) involves both cultural superiority and racial behavior based on this perception. Culture: According to one of the most widely accepted experts on culture and its diversity, Geert Hofstede, “the term culture generally comprises language, religion, customs and manners, material goods, aesthetics, and education” (Bode, 2007, 7). The definitions on culture and ethnicity seem to several factors in common and it appears that culture is a part of ethnicity. Linguistics: This term in its simplest sense means “the scientific study of language” (Misra, 2000, 15). Examples: An example of overt racism would be the actions of the Klu Klux Clan, who indulged in violent acts and openly stated their perceived race superiority. Any social institution providing counseling services only for majority cultural/ethnic group is an example of institutional racism and ethical misconduct. An LPC who is openly critical about ethical and cultural superiority can be accused on unethical practices. For example, the counselor can openly state that the practices followed by Indian communities regarding idol worship are not correct. While idol worship is ingrained in the Indian community, the LPC should take this into consideration and not try to change the beliefs of the individual. Rather the counseling should be based on the fact that the counseled person has certain ingrained religious values. With regard to linguistics, it can be said that an LPC should be aware of the communication problems considering the fact that not every American citizen or resident (especially immigrants) are not very comfortable with the English language. If the LPC shows some element of contempt with regard to the communication abilities of the counseled person, this again can be considered to be an ethical misconduct. Ethics Codes on Race: The ethical codes on race holds that there should be no unfair racial discrimination from the part of the psychologists in offering mental health care services to the needy clients. The ethical codes on race asks the psychologists to show no sorts of “unfair discrimination based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, socioeconomic status, or any basis proscribed by law” in their work related activities (Ethical Principles of Psychologists and Code of Conduct: 2010 Amendments). It means that psychologists need to respect and recognize various races and they should not discriminate clients based on their race or ethnicity. Ethnicity: The treatment and rights of Ethnic and Racial Minorities deserve attention as discrimination based on ethnicity has assumed covert and institutional forms. The ethical codes on ethnicity aim at preventing “any distinction, exclusion, restriction or preference based on race, color, descent, or national or ethnic origin” whereby the ethnic minorities are subject to discrimination, violation of human rights, and lack of access to timely mental health care (The Rights of Ethnic and Racial Minorities, 2010). It is therefore imperative that psychologists recognize ethnicity, ethnic values and ways of life of the clients in providing counseling or mental health services. Culture: The ethical codes on culture emphasize on the cultural heritage of the racial and ethnic groups. Zambrana et al, in this respect, argue that culture plays a dominant role in the patient-provider encounter and for them “the effect of culture is most pronounced when it intersects with low education, low literacy skills, limited proficiency in English, culture-specific values regarding the authority of the physician, and poor assertiveness skills” (Zambrana, Molnar, Munoz & Lopez, 2004, p. 37). Therefore, it is imperative that psychologists, therapeutics and practitioners maintain sufficient cultural competence so as to recognize culture and its impact on behavior. Linguistics: Linguistics plays a dominant role in the psychologist-client communication. According to Rice (2004), the duty of a linguist is to understand that “language belongs to the community” and to prepare himself “to work with bilingual education programs” (Rice, 2004, p. 11). Mental care providers should ensure that the information is provided in a language that is understandable and is easily followed by the clients. Mastery over the client’s native language or service from competent interpreters are essential for this purpose. This is very well suggested by Zambrana et al when the authors purport that “providers who are aware of and address potential communication difficulties, and who provide linguistically appropriate and literacy-appropriate information in the patient’s native language, interact more effectively with patients” (Zambrana et al, 2004, p. 38). Ethical concerns regarding race: If leaders or the dominant individual in an interaction (say LPC) chose to ignore the racial aspect of the person being counseled, “they can be hardly doing what is in the best interests of these clients, which is an ethical matter” (Corey, 2008, 53). As mentioned earlier in the paper ignorance of refusal to understand the diverse differences of the person being counseled (client) can be considered to be an ethical violation. The author states that a positive attitude regards taking the trouble to understand and imbibe ethnic differences will help to build a bridge of understanding and trust on the part of the person being counseled and the counselor. This in turn will help in making sessions more effective and also help to reduce or eliminate any ethical issues in the relationship. The problem faced by many LPC could be that the technical aspect of counseling can be applied universally irrespective of any racial or cultural differences. In other words, “practice - based on theories taught during initial training and subsequently developed into 'action theories' in the field - often reflects the assumption that a particular interviewing approach is transferable across a wide range of clients” (NGRF, 2004). So, such counselors are not taught about diversity in any form which in turn can affect their ethical behavior whether it is intentional or not. History of disregard for client ethnicity: Ridley provides an example of disregard of a patient who complained about racial discrimination in a hospital. Even though the incident happened during the 1960s, ethical factors with regard ethnic discrimination are evident here. The case in question involved objections regarding the attitude of hospital personnel towards colored people. The individual raised objections regarding this even though he was the only colored person who among numerous others present did so. The hospital authorities asked the patient why he acted in such a manner when others belonging to his same ethnic group chose to remain silent. Echoing the overall sentiments of the hospital authorities, the counselor in this instance “attributed the patient’s problems to personal or dispositional traits. The therapist completely ignored the context in which the so-called problems occurred – a partially segregated hospital” (Ridley, 2005. 59). In other words, the counselor did not understand that the outburst was due to a sense of segregation. On the other hand he (or she) might have felt a sense of race superiority and acted accordingly in condemning the acts of a perceived inferior ethnic group. Whatever may be the case, a clear instance of unethical behavior is evident from the case. This is despite the fact that colored people have been a fabric and part of the society for more than several centuries when compared to the ethical validity of other immigrant races. Ethical concerns regarding race: The given definitions of race and ethnicity only provide a broad picture of diversity. In other words there are common factors that connect two perceptions like diversity between races and ethnic groups. But certain differentiations between the two concepts have evolved over the years. “Ethnicity is a group classification of individuals sharing a unique social and cultural heritage from generation to generation. It therefore follows that ethnicity and race are not necessarily synonymous though common usage of the term ‘race’ in the literature ought to refer ethnicity or culture” (Dryden, 2000, 50). In other words, the colored people from Africa can be considered to be a part of the ethnic population in the United States while other immigrants can be seen as a new race. In spite of their differences in color and culture, the black population as a race, has been able to integrate into the social, political and religious culture or the United States. Ethical Concerns regarding Ethnicity: Practitioners come across many ethical concerns regarding ethnicity when they are totally unaware of the ethnic values, ways of life and socio-cultural problems that their ethnic clients undergo. Very often, practitioners and psychologists tend to follow the dominant culture and language whereby the unique ethnic traits of the minorities go unnoticed. Every mental health service provider should realize that the racial and ethnic groups have the right “to enjoy their own culture, practice their own religion and use their own language” and their cultural heritage, socio-economic, religious, and linguistic diversities need to be taken into account by the psychologists (The Rights of Ethnic and Racial Minorities, 2010). History of ethical concerns: The American Psychological Association has formulated a number of ethical principles and codes of conduct for the psychologists, therapeutics and practitioners due to the racial, ethnic, cultural and linguistic disparities in health care services. However, it should be noted that these codes of ethics apply to the professional lives of the psychologists only. The general principles put forward by the APA are aimed at instilling highest ethical ideals of the profession among practitioners and these general principles emphasize Beneficence and Nonmaleficence, Fidelity and Responsibility, Integrity, Justice, and Respect for People's Rights and Dignity (Ethical Principles of Psychologists and Code of Conduct: 2010 Amendments). The APA has also set ethical standards on Resolving Ethical Issues, Competence, Human Relations, Privacy and Confidentiality, Advertising and Other Public Statements, Record Keeping and Fees, Education and Training, Research and Publication, Assessment, and Therapy undertaken by the psychologists and their corresponding agencies or organizations. Types: The types of ethical concerns before a psychologist can vary from issues of confidentiality, dual relationships, payment and forensic psychology, racial discrimination, ethnicity, cultural diversity and linguistic disparities. Ethical concerns regarding culture: One of the most pronounced ethical concern regarding culture is the lack of culturally competent psychologists. In this respect, Edward P. Cannon argues that even though professional school counselors need to work in ‘more racially and ethnically diverse school settings’, “ most school counselor trainees continue to be from the dominant culture, raising the likelihood of culture clashes and ethical violations” (Cannon, p. 2). It is therefore a fact that most of these school counselors are unaware of the multicultural issues and the problems of their minority group students. It is expected that by 2023 more than half of the student population in the United States will be constituted by minority learners. As Sue et al. argues it is therefore imperative that “counselors should be self-aware, examine their beliefs and attitudes regarding other cultures, understand how various forms of oppression influence counseling, and use culturally appropriate assessments and interventions” (Cannon p. 4). It is therefore significant that the psychologists and other mental health providers become aware of their own racial and cultural biases and develop more of ethical sensitivity towards their clients. Ethical concerns regarding linguistics: Ethical framework in linguistics: Linguistics plays a pivotal role in the one to one communication between the psychologist and the client. It is important for the psychologist to communicate with the client in his/her native language for better outputs. However, when the client’s language differs from that of the psychologist, it adversely affects the psychological process. There is no doubt that racial and ethnic minorities face many barriers when it comes to health care due to language problems. In this respect, Zambrana et al argue that that racial and ethnic minorities with limited English proficiency (LEP) “experience multiple barriers to healthcare, encounter lower access to and availability of healthcare, and experience less favorable health outcomes” (Zambrana et al, 2004, p. 37). Translators: The role of translators in the psychological process becomes crucial when there are communication problems between the client and the practitioner due to linguistic differences. It is important that there takes place proper communication between the client and the clinician and in a way the translator acts as a uniting bridge between the two parties. Language of the community: Very often, the psychologists are linguistically competent in the language of the community. The language of the community becomes the dominant medium of communication for them and difficulties arise when there is difference of language between the client and the service provider. On the other hand, there can be psychologists who fail themselves to adapt to the values, concerns, and language of the community in which they render their services. Cultural gaps within the family: Distinguishing between generational gaps: A cultural gap between the families is another area that the psychologists need to focus on. The generational gaps among the family members can have a negative influence on the client and it is the duty of the psychologist to “help clients to understand/maintain/resolve their own socio-cultural identification; and understand the interaction of culture, gender, and sexual orientation on behavior and needs” (Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations, 2010). Respecting the family members: It is the duty of the psychologists to train the clients to respect the other family members in cases where the client’s problems stem from cultural or generational gaps within the family. For this, the psychologist should be better equipped with the cultural diversity that takes place from time to time and from generations to generations. Community structures: Similarly, it is essential for the psychologists to “respect the roles of family members and community structures, hierarchies, values, and beliefs within the client's culture” so that he/she is better equipped to understand the client’s problems (.Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations, 2010). Role of Religion on clients: Religion plays a pivotal role in psychology and psychotherapy as spirituality considerably affects the development of one’s psyche. Religious and spiritual influences on religion have long been discussed and researches have proved beyond doubt that ‘spiritual approaches to psychotherapy can be effective’. It has also been identified that “if a client comes from a spiritual and/or religious background this individual has a better chance of benefiting from this style of intervention; more than someone who does not approve of this method” and therefore an effective psychologist should never undermine the role of religion on the client’s psyche (Psychology and Religion, 2010). . Consideration of traditional healers: The psychologists can also make use of the good aspects of traditional healing practices. One should also keep in mind that there have been efforts in psychology to integrate traditional Healing Practices into Counseling Psychology, Psychotherapy, and Psychiatry. Role of the psychologist: The role of the psychologists in the mental health care process is crucial. It is imperative that the psychologist is professionally competent and gives due importance to ethical considerations. Therefore, the psychologists need to offer “services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience” (Ethical Principles of Psychologists and Code of Conduct: 2010 Amendments). The general ethical requirements of the psychologists demand that they “shall not make any false, misleading, deceptive, fraudulent or exaggerated claim or statement about the services of a mental health services organization or agency, including, but not limited to, the effectiveness of services, qualifications, or products” (Texas Administrative Code, Chapter 681, p. 1). Similarly, it is the duty of the licensee to prevent others from making misrepresentations regarding the above mentioned aspects. In the same way the therapeutic is prohibited to maintain a dual relationship with the client with a view to establish a non-therapeutic relationship. On the other hand, the licensee should not try to enter into non-professional relationship with the client’s family members or other near and dear ones of the client. Also a counselor is not supposed to provide counseling services to anyone who receives counseling treatment intervention from another service provider without the latter’s knowledge. The licensee needs to maintain accurate records of the clients for a minimum of five years from the last contact with the client (Texas Administrative Code, Chapter 681, p. 2). Broadly, a mental health service provider can vary from a licensed mental health professional, including a licensed social worker, a chemical dependency counselor, a licensed marriage and family therapist, a physician, a psychologist, or a member of the clergy. Under no circumstances the licensee should engage in sexual contact or sexual exploitation with the clients, even while treating sexual or marital dysfunction. Similarly, a licensee needs to report sexual misconduct by another licensee or mental health services provider to the respective authorities and in doing so the alleged victim has the provision to remain anonymous (Texas Administrative Code, Chapter 681, p. 5). Cultural barriers to psychologists: Cultural barriers cause a lot of troubles to psychologists. These cultural barriers mainly stem from lack of cultural competence and sensitivity from the part of the psychologist towards the client. As Zambrana et al make it clear it is essential that in order to “ensure quality healthcare and access for minority populations, care must be congruent with patients’ cultural, linguistic, and literacy needs” (Zambrana et al, 2004, p.38). Cultural competence: The growing number of patients of diverse racial, ethnic, cultural, and linguistic backgrounds in the United States has increased the need for cultural competence for the psychologists. As Zambrana et al point out “culturally competent care can improve the continuity of a patient’s care and health outcomes by increasing the understanding between patients and providers” (Zambrana et al, 2004, p. 38). In the same way, it is a fact that even though the percentage of ethnic minority has increased considerably since the 1990s the number of minority medical school matriculants has decreased tremendously in the United States. Cultural competent practices: Just as cultural competence is a necessary prerequisite for any psychologist, so is the need to develop cultural competent practices. Studies have shown that “delivery of healthcare to Medicaid managed care groups provides an opportunity to improve access and quality of care for Medicaid-eligible, low-income, underrepresented racial/ethnic minority groups” and there is no doubt that such cultural competent practices are to be undertaken by the psychologists (Zambrana et al, 2004, p. 43). Effective training: As cultural competence assumes greater significance in the client-psychologist relationship, it is necessary that the psychologists are specially trained to meet this professional requirement. The low-income racial and ethnic minority populations are to be offered timely primary care and the underserved populations need to be offered special attention. All these call for the necessity of effective training whereby the psychologists are competent enough to fulfill their roles. Discussion and conclusions To conclude, it can be stated that factors such as racism, ethnicity, culture and linguistics play dominant roles in deciding the ethical considerations in psychological practices. Similarly, confidentiality has been proved to be a major factor in psychologist-client relationship as the client is most likely to disclose himself or herself only when there is a trusting relation with the clinician and the client privacy is ensured. It is therefore imperative that “confidentiality laws serve the interests of family members, employers and society in general, by helping to reduce the impact of mental and emotional disorders and personal problems” (Ethics for Texas lPCs: Confidentiality). Similarly, information provided by the customer should be kept confidential and release of such confidential information should be done with the consent of the client. Similarly, the counselors are expected not to disclose information or confidentiality to requests from family members, attorneys, journalists, law enforcement officers, neighbors or other parties without the consent of the client. However, in certain cases there are exceptions to such confidentiality for legal purposes, judicial and administrative proceedings, and for prevention of harm to others; confidentiality has its limits when there exists “threat of harm to self or others, certain lawsuits, a court order, detention of a mentally disordered person for evaluation, and reasonable suspicion of abuse of a minor or dependent adult” (Ethics for Texas lPCs: Confidentiality). Regarding the publications or researches by the licensee it should be ensured that no participants suffer from emotional and physical harm. In the same way, is the duty of the psychologist to take into account the cultural diversity, ethnic and racial background, and the linguistic whereabouts of the clients in considering the ethical issues that surround psychology, psychotherapy and therapeutic practices. References Better, S (2008). Institutional racism: a premier on theory and strategy for social change, Rowman & Littlefield Bode, S (2007). The importance of culture, GRIN Verlag. Cambridge Dictionary (2010). Racism, Cambridge University Press, retrevied 01 November 2010 from, http://dictionary.cambridge.org/dictionary/british/racism Cannon, E.P. Measuring Ethical Sensitivity to Racial and Gender Intolerance in Schools. Retrieved 03 November 2010 from: http://www.jsc.montana.edu/articles/v8n20.pdf Corey, G (2008). Theory and practice of group counselling, Thomson Higher Education. Dryden, W (2000). Questions and answers on counseling in action, SAGE Publications. 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(September 2004). Cultural Competency as It Intersects With Racial/Ethnic, Linguistic, and Class Disparities in Managed Healthcare Organizations. The American Journal of Managed Care, 10 (Special Issue), 37-44. Read More