Asian Families: an overview

-Asian American has collectively referred to Americans whose families originated in many different Asian countries.

-Geographically, Asia includes counties encompassing the Far East, Southeast Asia, the Indian subcontinent (including Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam).  Pacific islanders sometimes get put into this group as well.

-There are about 32 primary different languages spoken.

-In 2000, Asian Americans were more likely than whites to have earned at least a college degree…but they were also more likely to have less than a ninth grade education.

-Asian families are different than western culture in the way the family unit is highly valued and emphasized throughout the life cycle. Asians embrace an “We” identity instead of an “I” identity.

-A lot of Asian countries have suffered trauma from war, political upheaval, etc.

-Asians are stereotypically seen as the “model minority” in that they are viewed to be high academic achievers and a group that doesn't create problems in society. This stereotype may actually increase family pressure and individual stress.  Asian women are stereotypically viewed as passive. Men are stereotypically seen as being controlling and physically attractive.

-The expression of mental health problems in Asian families seems to depend on the family’s level of acculturation.

-Some research has underscored six predictions of mental health problems among Asian Americans 1) employment or financial insecurity, 2) gender- Asian women seem more vulnerable, 3.) older age, 4) social isolation, 5) relatively recent immigration, and 66) refugee remigration experiences and post migration adjustment.

-Asian Americans have some of the lowest rates of utilization of mental health services. These low rates have been attributed to shame and stigma about using the resources, lack of financial resources, difference conceptions of illness and health, and lack of culturally competent services.

-Research shows that when they seek services, it is only when the problem is very severe and has stretched the family system to its limit.

-Asian Americans may turn to alternative treatments in the community (spiritual leaders, healers, natural remedies)

-The family unit—rather than the individual—is the most values. The individual is seen as the sum of all the generations of his or her family. What an individual does is a reflection on the larger family and ancestors.

-The Chinese have a saying. “The nail that sticks up will be pounded down”

-The dominant influence of patriarch still remains. Historically in China, a woman’s value is related to her giving birth to sons in order to preserve the family name.

-in 1979 the leadership in China instituted the “one-child family” policy (if you only had one child, you received better benefits from the government). Those who had daughters would often hide them with relatives and wouldn’t even name them.

In traditional Asian families, marriages are arranged by parents or grandparents to ensure the family prosperity and propagation of the husband’s family line.

-the primary relationships is likely to be the parent-child dyad rather than the husband-wife.

-Physical and verbal expression of love is uncommon.

-Divorce is relatively uncommon.

-the traditional role of the mother is to provide nurturance and support. The father’s role is to discipline.

-The strongest emotional attachment for women is usually to her children.

-Parents are expected to be cared for in their old age.

Asian American families in transition can be described into several major categories:

-Traditional families (usually consists entirely of individuals born and raised in Asian countries)

-Families in “cultural conflict” (usually has American-born children or children who were very young when they moved to the US)

-Bicultural families (well-acculturated parents who grew up in major Asian cities and were exposed ot urbanization, industrialization, and western influence. Many of these people come to the US as young adults. Some were born in the US but raised in traditional families)

“Americanized” or highly acculturated families (mostly parents and children who were born and raised in the US…may not identify with their Asian roots as much.)

-New millennium families (previously referred to as interracial.

Treatment

-The clinician needs to assess 1) the internal family system which includes understanding the individual members and family subsystems, and 2) external factors, which include the impact of community and other environmental stressors.

-Asian families undergo rapid social change and cultural transition, so it is important to get a full/relevant history.

-The clinician will need information on the neighborhood and larger community, including the availability of role models, housing conditions, economic climate, job ability, and education system for children and adults, etc.

-Family stress may be caused by Role Reversal in which the Asian parents become dependent on their English-speaking children, which can lead to anger and resentment.

-Asian American families value hard work, and economic stress has been significantly associated with depression

-Many traditional Asians do not accept western explanations of mental health. On page 280, there is a list of good questions to ask in the assessment phase in which the clients can discuss their cultural and religious perspectives on the presenting problem, past coping styles, and health seeking behaviors.

Phases to follow in therapy:

Beginning phase: engage the family

• 1.       Initial appointment should be made with the family’s “decision maker”
• 2.       A brief explanation of the clinician’s role and training background
• 3.       Address the family in a polite, somewhat formal manner.
• 4.       They may ask the clinician personal questions. The clinician must feel comfortable answering such questions
• 5.       Disclose familiarity with that culture to make the cultural connection. For the clinician who is not familiar, it is important to show interest.
• 6.       Ask non-threatening personal questions. Avoid direct confrontation, demands for greater emotional disclosure.
• 7.       Empathize with the client’s feelings of shame and encourage them to verbalize such feelings. Assure them of confidentiality.
• 8.       Establish credibility right away to ensure the client will return (use professional titles when making introductions, displaying diplomas awards, etc. , obtaining sufficient information about the client before seeing them the first time, offering a possible explanation of the cause of the problem, showing familiarity with the cultural background)
• 9.       Help the client understand the reasons behind questions in the assessment/evaluation process
• 10. For the first session, allow more than the usual 1 hour…especially if an interpreter is being used.
• 11. Some discomfort may occur around certain topics (sexual orientation, sexual intimacy, etc). After credibility is established, acknowledge that some difficult areas may need to be discussed.

Second phase: involving Family members in therapy.

-mutual goal setting  

Third Phase: Problem solving.

-focusing on the problems as presented by the family

-apply a psychoeducational approach

-assuming multiple helping roles

-indirectness in problem solving

-employing the reframing technique

-capitalizing on family strengths and community support

-utilizing intermediary/go-between functions

-understanding the family’s communication style

Termination Phase

Sue & Sue ch. 16 Counseling Asian Americans and Pacific Islanders

Characteristics and Strengths

Asian Americans: A Success Story?

• Over half of Asian Americans have a bachelor's degree (30% of whites do)
• 20% have an advanced degree (10% of whites do)
• Lowest high school dropout rate (2%)
• Median income is $64,308 compared to $49,445 for whites
• Does not take into account the fact that more Asian-American families have dual income
• They also have an overall higher level of poverty than whites (especially Hmong, Guamanian, Indonesian, and Cambodian immigrants) 
• Asian Americans underutilize mental health services (cultural? inaccessibility of resources? etc.)
• experience of discrimination throughout history and current.

Look behind the success myths to understand the clients' historical and current experiences of being an Asian American.

Collectivistic Orientation

• Be aware of the cultural values. Many Asian American families may look enmeshed. Make sure to ask something like: "How does your family see the problem?"

Hierarchical Relationships

• Males and elders occupy a higher status. Definitely more traditional (and different groups vary- Filipino families are more egalitarian with Korean families more patriarchal, etc.)
• Determine family structure and communication pattern. 
• If structure is unclear- address the father first and then the mother to be most productive 
• Maybe having each person in the family address the therapist may be most effective. 

Parenting Styles

• They tend to be more authoritarian and directive than Euro-American families
• Shame, guilt induction, and love withdrawal are often used to control and train children
• Criticism rather than praise is believed to be effective in changing behaviors.
• Western-style/egalitarian parent-effectiveness training strategies may run counter to traditional child-rearing patterns.

Emotionality

• Large/public displays of emotion are not celebrated. It is seen as a lack of self control and maturity
• If a client shows discomfort in a session, instead of saying "you look uncomfortable" it may be more acceptable for the client if you say "This situation would make someone uncomfortable"
• Asian Americans may also may not be as verbal about love- showing it through actions instead of saying "I love you"

Holistic View on Mind and Body

• They may express emotional problems through somatic complaints because physical problems are culturally accepted. 
• Treat somatic complaints as real problems and ask "Dealing with headaches and dizziness can be quite troublesome; how are these affecting your mood or relationships with others?"
• Deal with the somaticism and the consequences of being "ill"

Academic and Occupational Goal Orientation

• Asian American children have higher academic performance but also have higher report of feeling isolated, depressed, and anxious and report little praise for their accomplishments from their parents. 
• Sometimes parents and children have different ideas about what the kids should do. In therapy you could work with the client to brainstorm ways to present other possibilities to the parents. 

Cultural Strengths

• Family orientation
• Collectivity
• Harmony in family relationships 
• Respect for elders

Specific Challenges

Racial Identity Issues

• Asian Americans are often placed in situations of extreme culture conflict and experience pain and agony regarding behavioral and physical differences. 
• Asian American college women report lower self-esteem and less satisfaction with their racially defined features than caucasian. 
• Individuals undergoing acculturation conflicts may respond in the following manner:
• Assimilation (wanting to be part of the dominant society and excluding the dominant group)
• Separation or enculturation (ID with Asian culture)
• Integration/biculturation (retaining may asian values and learning skills and values to adapt to dominant culture)
• Marginalization (Perceiving one's own culture as negative but feeling inept at adapting to the majority culture)

Acculturation Conflicts

• The issue of not quite fitting in with their peers yet being considered "too Americanized" by their parents is common. 
• Parent-child conflicts are among the most common problem. The larger the acculturation gap between parents and children- the more conflict.
• Reframe these differences and problems as due to acculturation problems
• Therapist can function as a culture broker in helping the family negotiate conflicts with larger society

Expectations Regarding Counseling

• It's important to carefully explain therapy and treatment because psychotherapy may be a foreign concept for many. 
• Be careful not to impose techniques or strategies
• What is expected by Asian clients in an active role by counselor in structuring the session and guidelines on types of responses that they will be expected to make.
• Clearly describe client's role in therapy process
• Therapist should direct therapy sessions but should ensure full participation from clients in developing goals and intervention strategies. 

Racism and Discrimination

• Assess the effects of possible environmental factors on mental health issues in Asian Americans and help insure that clients not internalize issues based on discriminatory practices. 

Guys, sorry!!! My family of origin presentation in combination with my under the same moon paper has been taking up all of my time yesterday, last night, and this morning. I didn't have a chance to finish the summary.


Acculturation Vs. Cultural Identity

In this article, J.R.P.C spends some time discussing “acculturation”/ “becoming more American” and the expectation that some well-meaning people put onto immigrants/minorities…under the assumption that it would be “better” or easier for them.

The purpose of the chapter: to revise and challenge the concept of acculturation and introduce the concept of cultural identity formation.

This is done through the authors presenting their personal and professional backgrounds and the ideas the conceptual ideas that led them to the creation of Transgenerational Cultural Identity Formation.

Three Different Cultural Backgrounds.

J. Ruben Parra Cardona

-came to the U.S. as a high school exchange student when he was 18.

-He expected to be something new and cool (like how Americans are seen in Mexico) but he felt like a ghost.

-He experiences overt bullying, racism, and loneliness. He felt like others were angry at him which started his process of self-hatred.

-Comparison to Americans started to take place, hated his ethnic identity, and started idealizing Americans.  

-After high school he went back to Mexico for his undergrad but then decided to return to America for graduate school in MFT. He had the experience of working with Kenneth Hardy which introduced dynamics of oppression and concepts of white privilege. This caused him to become more aware and take notice of discrimination and be able to link it back to his skin color.

-Gradually, he become more in touch with his “brownness” and the many ways that immigrants feel pressure to acculturate and blend in.

Richard S. Wampler

-Of Swiss-German decent that came to America several generations back.

-Grew up being almost unaware of cultural/ethnic diversity as his elementary school was all white 

11/12/14: Ingoldsby 2006

Families in Latin America

Intro

• This includes Mexico, Central and South American, and the Carribean.  
• 2 main undercurrents--Poverty and Patriarchal norms (Machismo).
• Women believe their purpose in life is to have children so they usually avoid birth control.

Mate Selection

• A study showed that US teens looked for independent factors like being sexy and having money as more important than liking children and such, whereas Guatemalans ranked more "collectivist" ideals as higher than the independent traits.  
• In Mexico they were mixed, and in Venezuelan mate selection characteristics were similar to the US.
• All throughout latin american, the higher the education level of the woman, the later her age of marriage is.
• There is lots of consensual unions and cohabiting in Latin America.  
• Overall, Latin American couples tend to marry earlier and be more endogamous (marrying within the same culture) than US couples.  

The Latin American Family

• Argentina
• Women are starting to get more education and going into the workforce, men are getting more independent (moving out of their houses before they get married).  
• Overall, they're currently less patriarchal with greater equality for women.  But the households are less financially stable.
• Brazil
• Predominant language is Portuguese. 
• Nuclear families, relatively small
• Divorce was legalized in 1988.
• Parents discipline their children sometimes with abuse and society doesn't recognize it as such.  
• Working towards more individuality in the culture.  
• Costa Rica
• Only half the population is a nuclear family with 2 parents.  
• Women sometimes go into the workforce
• Patriarchal values are strong
• Women don't know if they can be happily married and enjoy employment.  
• Mexico
• FAMILY is important!!!
• 75% are nuclear families, and the rest are extended families.  
• Marriage is popular
• Men aren't participating in housework as quickly as women are entering into the workforce.
• Machismo
• Peru
• 50% lives in poverty.  
• "Macho" double standard of sex--Men can't control themselves and women should keep themselves chaste.
• Having children is a mark of faithfulness in a wife and a way to keep the husband around.  But they used to do 7 children on average in a family--in 2002 it's down to 3 because of decreased fertility in urban women.  
• Lots of attempts to migrate to other countries for better opportunities once a man has left a family. 
• Venezuela
• Mother is stable decision maker, grandmother is focus of family--not father.
• Husbands and fathers are marginal characters--even when in formalized marriages.

Family Ideals

• Familism
• Places family ahead of individuals' interest and development. It highlights loyalty and cooperation.
• A sense of duty and strong belief in having children.
• Generally, no sex before marriage, have parents' approval on dating partner, and endogamy.
• Machismo
• Aggressive, masculine, strong, powerful physically.  
• A true macho shouldn't be afraid of anything.
• Should be able to hold their liquor
• Hypersexual--impotent and homosexuals are scoffed at.  
• To take advantage of a young woman is a sense of pride and prestige, not blame.  
• A married man should have a mistress and other casual encounters.  "The woman loves, but the man conquers"
• Avoid feminine traits.
• Female Support of Machismo
• Marianismo-women are semidivine, spiritually and morally superior to men.  

Street Children

     Effect of Machismo--Pushing kids to independence so early they live on the street.  

• Who They Are
• Ages 8-18
• They form their own community.   Don't really want to be back in their families. They beg and sell.
• Why They Leave Home

Family Violence

• Lots of family violence that isn't talked about.  
• Latinas are more tolerant of physical and emotional abuse in families.

Conclusion

• Times are changing in Latin America--people are becoming more egalitarian in their views and women are gaining power in relationships and marriage, but the change is slow.  

11/12/14 Falicov 2008 -- Transnational Journeys

Transnational immigrants are those that maintain multiple relationships (familial, economic, social, religious) that span geographic, cultural, and political borders.
-Current technology and communciation advances have made this possible when in the past, immigrants that came alone or with parts of their family had to either cut ties, maintain strained relationships, or return to their countries.

These families present different challenges in therapy as their situations are so unique and painful.

A family's migration narrative (helped by therapist's questions) need to pay attention to the past and the current complex interactions among all migration players.

Separations and Reunifications

Spousal Relationships

• The reunion of husband and wife is really difficult to adapt to! There are problems with trying to be close again or even problems with affairs. "Spouses grow apart and fall out of love, become jealous, feel envy, and may become depressed at both the decision to separate and the decision to reunite."
• A person's cultural changes as they stay in a country or go to another can also affect how relationships are affected.

Relationships between Parents and Children

• Sometimes sibling groups get separated and those who are left behind are jealous of the ones who went, etc. 
• Adjustment problems are also pretty common 

The Nature of Connections at Long Distance

• People who come to the states for work are most often sending money back home to kids or spouses. The longer someone has been in the US, the more money they are able to send back home. 
• People from home send pictures and CDs and try to keep the connection to home strong.
• To keep communication strong- therapists can suggest frequent phone calls and can 
• Routines and truths aren't shared always between people

11/5/2014 McGoldrick Chapter 5: African Americans

11/5/2014 McGoldrick Chapter 5: African Americans

Unlike other immigrants most African Americans came not by choice, the slave trade brought many of them.

At the time Africa was actually doing really well and was coming along as a civilization.

The Europeans who came over to the states weren't skilled in agriculture and there weren't enough indentured White servants to make plantations profitable.

AFRICAN AMERICANS IN HISTORICAL AND CULTURAL CONTEXT

• Somewhere in the 15th century people started to associate sinister qualities with "black" people who were from African and non-Christian, while those who were "white" represented Christianity and Europe.
• From 16th to 19th century it is estimate that Africa lost about 50 million to death and slavery
• Estimates of the mortality rate in the Middle Passage, the boat trip from Africa to American was 20-33%.
• With the Declaration of Independence six states banned slavery and in 1808 the federal government banned it as well, but permitted the institution of slavery to continue in the states it was already in and spread south of the Ohio river.
• In the South  only 25% of whites really practiced slavery, but most Whites supported slaver because they believed their prosperity depended on it and because it gave even the poorest of white people a sense of superiority.  
• Many uprisings, underground railroad, rebellions etc.
• 1863 was The Emancipation Proclamation and 1865 was the passage of the 13th amendment to end slavery and 1866 Gave African Americans full civil and voting rights.
• Although these laws had been past, they weren't honored in many parts of the country for many years, until the passage of the Civil Rights Act in 1964.

Demographics

• 2000 US census: 34.7 million (12.3% of population) are African American
• There is a real struggle between African Americans and other immigrants because of their experience and history with racism.

Migration to the US

• People are still migrating from the African countries, so therapist must be aware of this.
• From 1924 to 1965 migration of people of color was restricted as they were viewed as less desirable. 
• There was tremendous emotional toll on those who left their families in the South to try to create a better life somewhere else.  
• When working with immigration commons themes are :
• sense of loss of family and family fragmentation, social dislocation, economic advancement comes at great cost, difficulties assimilating, and anger.
• Ask about their migration, the good and the bad, etc.

Spirituality

• historically very important.  Address spirituality with African Americans as it may or may not play a role in their lives.

THERAPY ISSUES

Gender

• As with most, it is patriarchal, however there are a number of example of more fluid gender roles and is probably more egalitarian than anything.
• Still male violence persists
• Many African American families won't seek therapy services because they don't want to expose their men to the racist criminal justice system.
• Genograms can be helpful to explore inter-generational family stores about gender roles, marital ties, and power.  

Class

• Education and socioeconomic advancement are values of this community although many are still entrenched in mulitgenerational poverty.

Sexual Orientation/Heterosexism

• LGBT community still fights for recognition in the African community.
• Homosexuality is still taboo and hidden
• therapist should challenge their heterosexist assumptions and help them understand the impact of homophobia.

Response to Treatment

• There is still mistrust
• Important to let them share and get their stories out without judgment

Social/political/economic impact

• Typically have experience oppression in one or all of these areas and it has impacted emotional health

Grief/Rage/Loss

• Lots of this in reaction to micro-aggreasions, slights, insults, racism, etc
• Talk about it!

Awosan, Sandberg, and Hall article

Here is the Abstract from the article:

Past research on Black clients’ utilization of therapy focused on the barriers that prevent Black clients from attending therapy and the reasons for these barriers. However, few studies have been conducted that focus on how Black clients attending therapy actually experience these barriers. This study utilized both Likert and open-ended questions to examine the obstacles 16 Black clients face in their attempts to attend family therapy. The most frequently identified obstacles were related to concerns over family member response and cultural barriers to therapy. Participants also reported concerns about racial and ⁄ or cultural differences and a lack of understanding by non-Black therapists. The implications of this study addressed how to effectively meet the therapeutic needs of Black clients.

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-It is important to recognize the variations among Blacks as these differences relate to the underutilization of therapy. People of African descent are not all the same.

-Blacks are fairly united in their negative perceptions of therapy. Their ‘‘negative’’ attitudes toward therapy can be linked to shared experiences of racism and oppression in a White society. Some differences, however, do exist based on SES and other factors.

African Americans and Mental Health Services

-Clinicians need to understand a concept termed Eurocentrism in the literature. Eurocentrism is characterized as a perception in which European (White) values, customs, traditions, and behaviors are used as the exclusive normative standards of merit against which other races and events in the world are viewed

-In order to understand the reluctance of many Blacks to engage in therapy, it is crucial to understand the perceptions and experiences in therapy of this population

-The difficulty for many Blacks in attending an institution that considers Black culture, values, and practices to be inferior or not normal has been indicated as one of the reasons why Black clients underutilize therapy and discontinue therapy after a few sessions.

-Misdiagnosis of Blacks in the mental health services has a profound connection to the pathologization of Black culture.

most non-Black clinicians lack empathy or understanding of Black culture and system values

-Stereotype or overpathologize Black people. Racist assumptions and multicultural ignorance of some clinicians have led to the misdiagnosis of Black clients. Consequently, the fear of being misdiagnosed, stereotyped, or pathologized keeps many Black people from seeking mental health services,

Mistrust

-historical acts of betrayal and oppression such as the Tuskegee syphilis study, among others, has laid the foundation of great and valid distrust

-most Blacks employ what is known as cultural mistrust in their interactions with Whites.

-this concept of cultural mistrust undeniably influences Black clients’ self-disclosure to White therapists and attitudes about therapy in general

-Black clients assess for levels of comfort and safety in the initial stage of therapy by observing the salience of cultural and ⁄ or race identity with the therapist and cultural understanding or sensitivity of the therapist

-Blacks are attuned to pay closer attention to the ways non-Blacks perceive their skin color and ⁄ or culture. The trust is therefore an essential element in obtaining and maintaining therapeutic services.

-Mistrust can hinder Black clients from disclosing ways that racism is connected with many problems they bring to therapy. Blacks fear how a White therapist, or therapist of color whom they perceive as being aligned with Whites by virtue of being members of the same social class, would react or respond to these problems in therapy.

Risk of Self-Disclosure in Therapy

-It can be dangerous for Black clients to self-disclose to White therapists whom they perceive as representing the oppressor. Self-disclosure in an environment that Black clients perceive as unsafe, and to White therapists whom they have some level of cultural paranoia for can impede the therapeutic process by making it less beneficial and effective for Black clients.

-It is crucial for White therapists to consciously and consistently address issues of power, privilege, racism, and oppression.

-the person with the most power also carries the greatest responsibility in that relationship.

-therapists need to embrace their responsibility and work to reconcile their own lack of historical cultural understanding and cultural sensitivity toward Black clients.

The Field of Marriage and Family Therapy and Black Clients

-MFT has struggled to recognize and focus on the topic of race and culture.

-New research is being done

Current Study

-This study is one of the first in the field of MFT to seek the perspective of Black clients who did attend family therapy, particularly regarding obstacles they face in their effort to utilize therapy.

Obstacles Relating to Lack of Family and Cultural Support for Therapy

- Concerns relating to a lack of family and cultural support for therapy were the barriers participants identified as the most difficult to overcome.

- The results of this study indicate that some participants see therapy as a sign of weakness or associated with being ‘‘crazy,’’ which is supported in extant literature that there is a stigma of therapy in Black culture

- Reactions of friends and family, suggesting there is real fear of stigmatization or rejection by family members or the larger community

- the cultural belief that a strong family should be able to resolve issues without professional help.

- belief that family problems should be kept within the family and not be exposed to the public.

Obstacles Relating to Working With Non-Black Therapists

-most Black clients prefer Black therapists to White therapists

-Studies suggest that African Americans would likely come to therapy if they know that the therapist they would see is African American.

- ‘‘lack of cultural understanding of therapist’’ was indicated by participants as a somewhat difficult obstacle to overcome in their attempt to seek family therapy.

- Need for Black clients to feel that their therapists have an ‘‘adequate knowledge of African American life’’ and do not need to ‘‘struggle to accept or understand them’’

- a therapist’s lack of cultural competency, awareness, and sensitivity toward Black culture and families can impede trust in therapy between Black clients and White therapists.

- ‘‘negative views about therapy’’ was significantly correlated with both ‘‘risk of being blamed by my therapist for my problems’’ and ‘‘fear of my therapist being racist.’’

Implications for Clinicians

-Black clients are often wary of working with White therapists.

- family therapists can address this concern of Black clients by taking active steps, both in and out of session, to adopt a multicultural perspective and approach in therapy.

- Racial awareness as ‘‘the ability to recognize that race exists and that it shapes reality in inequitable and unjust ways’’

- individuals who are racially sensitive ‘‘actively challenge attitudes, behaviors, and conditions that create or reinforce racial injustice’’

-Self of the therapist work is important

- family therapists must learn how to discuss race in session.

- the therapist would need to discuss with the client how it may be hard for him to feel safe enough to be honest.

- a culturally sensitive therapist would not place the responsibility on the client to speak up when the ‘‘white’’ comes out of her toward the client, but would instead use her inherent power as a therapist (and the accompanying responsibility that flows from it) to monitor herself through self exploration and supervision

- Taking extra time to process issues of confidentiality and privacy can show Black clients that a therapist is aware of past exploitation of Blacks both in and out of therapy.

- Clinicians need to understand the origin of barriers and how to address them in therapy.

- Most participants were highly religious. A therapist can effectively utilize a strength-based perspective by asking clients how spirituality and religion can serve or has served as a positive resource in their efforts to deal with life’s problems.