Intercultural Processes and Human Diversity

Dr. Hillary Goldsher, Psy.D, MBA

Hillary Goldsher

Clinical Psychologist

View Profile

My hypothesis about Tham is related to her sense of culture and identity. Tham is very tied and connected to her Vietnamese heritage. She regards her self and her family as quite separate from the American culture. She feels uncomfortable in her environment and is having difficulty establishing meaningful connections with individuals or with the community. As a result, she tends to isolate herself from the larger society. This leaves her feeling sad, helpless, and frustrated. She is experiencing physical symptoms associated with this psychological stress. In Tham’s culture, it is perhaps more acceptable to experience physical rather than psychological problems. Consequently, Tham experiences stress psychosomatically. Tham appears to be experiencing a significant degree of acculturative stress. An individual faces a myriad of changes and feelings when they come into contact with a culture that is different from their own. A great deal of stress can emerge from the process associated with the transition into a new culture (Berry 1998). Stress often continues to exist or even grow as one attempts to survive and thrive in a new culture. Tham is likely struggling with this difficult process. She probably feels conflicted about the acculturation process. On one hand, she desires for herself and her family to fit into the surroundings and to feel connected to the community. Conversely, she wants to facilitate an environment for herself and her family that allows for the observation and celebration of the Vietnamese culture. Her son is beginning to immerse himself in the American culture. Tham is surely concerned that her son will become increasingly disconnected from his Vietnamese heritage. Additionally, she is concerned that he will adopt a lifestyle that could be dangerous in order to fit into his surroundings. Adding to these stressors is the isolation Tham must feel in her current environment. She is widowed and lives in a predominantly white neighborhood. One moderating factor of acculturative stress is the availability of a network of social and cultural groups which may provide support for those entering into the experience of acculturation (Berry 1998). Tham is not connected with any particular group to help her through this process. She does not seem to be affiliated with any other Vietnamese families making this same transition. This lack of contact likely underscores her feelings of separation from the society at large.

It would be critical to understand several factors related to Tham’s culture during the treatment process. It would be important to learn about the role of emotional expression in the Vietnamese culture. Is emotional expression valued or discouraged? Additionally, is would be important to know if self-disclosure outside the family or community is acceptable. If the culture tends to frown upon emotional expression and self-disclosure, it may be difficult for Tham to express her feelings. It would be mandatory to understand this dynamic in order to develop an appropriate intervention. It would also be important to understand the role of non verbal gestures in Vietnamese society. Tham tends to avoid eye contact. Eye contact may be considered inappropriate in Vietnamese culture or amongst individuals outside the family. Clarifying this information would put her lack of eye contact in context. With this information, it would be possible to determine if this practice was a clinical or cultural issue. It would also be helpful to understand the child rearing practices in the Vietnamese culture. This information would help guide the development of an approach for Tham to deal with her son. Finally, it would be helpful to understand Tham’s acculturation goals. Her level of desire to acculturate or assimilate to the American culture is critical in understanding this client. If Tham, is uninterested in further acculturation, then the goal of therapy should be related to the management of stress related to this issue. If Tham seeks further acculturation, then the treatment plan can focus on developing internal and external resources to facilitate the process.

It would be critical to adopt a comprehensive perspective regarding the current experience of an Arab American in the United States. The climate in the United States has changed since recent world events such as the tragedies of September 11th. Some Americans have assumed a negative attitude towards Arab Americans because the perpetrators of these horrible events may have been of Arabic descent. Hassan’s negative attitude towards Americans may be quite justifiable. He may be experiencing real prejudice from individuals and groups within the United States. It may be true that certain Americans are interested in disrupting the lives of Arab Americans. It is important to understand Hassan’s situation through the lens of this new reality. His anger and fear is not without merit and this fact needs to be reflected in the therapeutic process. It is equally important to express empathy towards his feelings about his and his family’s experiences in this country. Additionally, Hassan and his family are in the midst of the acculturation process. This process creates stress as individuals attempt to establish themselves within a culture that is separate from their own. It appears to be important to Hassan to retain his association with Islamic traditions. He does not seem particularly interested in accepting the traditions of the American people. Consequently, he may be experiencing a sense of separation between himself and the culture at large (Berry 1998). This can create an enormous sense of isolation and despair for an individual as they refrain from participating in the larger society in order to maintain traditional practices. The recent attack that took place against Hassan must have been exceedingly traumatizing due to the aforementioned factors and the brutality of the crime itself. It would be critical to express my understanding of his feelings of anger and distress regarding his current situation. It would also be important to discuss the conflict he must be experiencing regarding his need to adjust to the surrounding culture and his need to retain his Islamic values and culture. Finally, it would be helpful to consider the anxiety that Hassan may be experiencing due to fears surrounding the therapeutic process. Men are often quite anxious when they come for therapy. The major cause of their anxiety centers around the fear of having to acknowledge to himself or the therapist that he is afraid. This admission can feel like a loss of control (Scher 1990). Oftentimes, the primary goal of an Arab American male is to protect the honor and well being of his family. Psychological problems may be regarded negatively. Seeking help outside the family may also be considered undesirable. It is therefore critical to reassure Hassan of his current mental strength and stability prior to a discussion about his areas of concern (Erickson 2001). It is important to be aware of these potential issues and to demonstrate patience and empathy as Hassan finds a way to express his feelings.

It would be critical to maintain an awareness of Rosa’s needs and goals with respect to the therapeutic process. It appears that family support and involvement is very important to Rosa. It would first be prudent to confirm that this assumption is true. If she confirms her desire to have her family involved in the process, it may be helpful to include Rosa’s sister and/or daughter in one or more sessions. This strategy may help Rosa to feel more open about sharing her feelings and discussing her difficulties during the therapeutic process. It would also be important to uncover Rosa’s long term goals for herself. She may or may not be interested in bettering herself from an educational standpoint. She may not be interested in learning how to stand her ground around her extended family. She may be solely interested in learning to better cope with the stress that she experiences as a result of the pressure from her husband and his family. It would be crucial not to put my own ideas about what might be good for Rosa’s life in the way of what Rosa believes is best for herself. This would be challenging because my tendency would be to guide her towards the pursuit of education, independence, and self-confidence. This path is quite similar to my own personal and professional journey. However, I must follow Rosa’s lead and respect the tenets of her culture which may discourage women from the aforementioned goals. With this in mind, I would want to know about the role of women and family within the Mexican American and El Salvadoran culture. Latino cultures tend to place great importance on family unity, welfare, and honor. The emphasis is on the group rather than on the individual. There is a deep sense of family commitment, responsibility, and obligation. (Garcia-Preto 1996). With this in mind, I would introduce the possibility of including the extended family in the therapeutic process. This option may facilitate a more palpable solution for Rosa and her family given the aforementioned cultural tendencies. I would also need to understand how religion fits into Rosa’s life. It appears to serve as a positive force in her life and may serve as a support system that could be highlighted or strengthened during the therapeutic process. I would also try to better understand the cultural conflict between Rosa’s family and Joe’s family. This may provide me with valuable insight into the family network. Finally, it would be important to know how both cultures view the pursuit of psychological services. This would provide insight into how this process will be received by the rest of the family. There is a potential for countertransference issues to surface within the context of this relationship. I could imagine that I may be frustrated or even angry at Rosa for not showing more fortitude or independence. I may perceive her as weak and unwilling or unable to progress. However, this would likely be a result of my own feelings about my mother’s ineffectiveness as a mother. It would be critical to be cognizant of this process so I would be available to support Rosa in her therapeutic goals and not impose my own agenda in the process.

Sylvia’s fear regarding the idea of embracing her Jewish identity may stem from an immense fear of rejection from both her family and from the larger society. Sylvia’s parents actively distanced themselves from their Jewish identity in an effort to blend into the surrounding culture. This sent the message to Sylvia that identification with the Jewish religion will result in rejection and abandonment. Given this mindset, it was critical for Sylvia to deny her own Jewish identity.
To do otherwise would be inviting disapproval and rejection from her parents and from the rest of the culture. She may have felt that an acceptance of her Jewish culture would somehow signify a rejection of her parents. Another explanation regarding Sylvia’s Jewish identity issues may be related to her relationship with her grandmother. Her grandmother shared many tragic stories with Sylvia about the Holocaust. Sylvia may have experienced guilt or distress about the tragedy that befell her ancestors. As a result, she may have regarded Judaism as a weakness or as a handicap given the extreme events of the Holocaust. Given her parent inability to discuss their religious affiliation, Sylvia may have decided to turn her back on her religion to avoid the discomfort associated with the aforementioned feelings and conflicts. If the first hypothesis is correct, an appropriate treatment goal would be to help Sylvia independently consider her Jewish identity. This would necessitate an understanding of her fears associated with their own Jewish identity. This would also require Sylvia to examine the implications of accepting or rejecting her Jewish identity on her own terms. It would be critical to understand the experience of Jewish Americans in the United States. This would provide insight into the potential motivations associated with the denial of one’s Jewish identity. It would be also important to understand the role of family within the Jewish culture and within Sylvia’s family. This would provide some information about Sylvia’s conflict associated with her religious identity versus her parent’s religious affiliation. Again, she may fear that an acceptance of her Jewish identity would be a rejection of her parents. It is important to understand if this belief has merit. If this belief if true, it would be critical to explore the impact on Sylvia. If this belief is false, it would be important to discover what other issues are standing in the way of Sylvia’s ability to embrace or acknowledge her Jewishness. It would also be important for me to carefully explore my own feelings regarding this issue. I am a Jewish woman that is proud of my Jewish identification and culture. I am not extremely religious but I consider myself Jewish and regard this aspect of myself as an important part of my identity. It would be critical that I avoid bestowing my own beliefs regarding Jewish identification on Sylvia. I would have to carefully avoid the impulse to guide her towards a path that involves acceptance of her Jewish religion. This process can only be guided by Sylvia’s desires. How Jews develop more positive relationships with their Jewishness varies from person to person. Rachel Siegel, a Jewish therapist, developed guidelines for working with Jewish identity issues that may be applicable to Sylvia’s situation. Siegel recommends three tasks: identify sources of Jewish pain, anger, and conflict, identify Jewish sources of joy and healing, and identify positive experiences of individual and community Jewish celebration and introduce Jewish self affirmations (Langman 1999). It would be necessary to identify Sylvia’s goals regarding her Jewish identity before employing Segel’s model. There is a clear professional ethic to respect individual dignity, uniqueness, and freedom of choice. Imposing therapists’ values on clients violates this ethic (Lannert 1991). Even if Sylvia decided to embrace her Jewish identity, it would be important to ensure that I refrain from trying to influence what the extent of that identification should be. I certainly have a bias towards the way in which I incorporate Judaism into my life. This bias needs to be kept out of the therapeutic process. I would need to continually check in with myself to ensure that I am not attempting to influence Sylvia’s view or practices associated with her religious identity.

Part II
This class has had a significant impact on my life both professionally and personally. I began this experience with the sincere albeit naïve belief that I was not prejudiced against any particular group. My belief came in part from many legitimate and positive experiences with minority groups throughout the course of my life. I was unaware of any negative perceptions or beliefs that I held about any specific minority group. In fact, I touted the belief that all races, cultures, and groups were absolutely equal. However, I soon discovered that this denial disregards the central importance of color or ethnicity in the psychological experience of the client (Ridley 1995). The personal revelations that emerged from this class shattered these innocent and erroneous beliefs. I learned that I do have prejudice thoughts, perceptions, and beliefs. I also learned that the notion that all cultures, groups, and races are equal ignores and minimizes the experiences of minorities in this country.

The above journey happened slowly and over time. At first, I attempted to deny any feelings of prejudice towards minority groups or individuals. In retrospect, I believe I was trying to ward off the feelings of guilt and shame that would accompany this admission. Fortunately, I had the opportunity to listen to and learn from my classmates. Many of them were willing to share their subtle and direct feelings of prejudice. The class was structured in a manner that allowed for discussion rather than debate. The Becker article underscored the importance of creating an atmosphere where opposing views can be expressed without judgment and anger (Becker 1995). Though this ideal was difficult to achieve, this notion governed the majority of our classroom discussions. As a result, I was able to recognize myself in some of their comments and could no longer deny that I possessed similar sentiments. What I discovered still feels shameful and distressful. However, I learned that acknowledging and discussing such beliefs initiates the process of coping, learning, and change. I realized that I do maintain prejudice feelings and beliefs. I recalled several incidents during which I made an erroneous and impulsive assumption about black men. During these events, I saw a black man when I was alone and felt that he posed a threat to my safety. Only in retrospect did I realize that I would not have had the same reaction if that same man had been white. As I tried to understand this pattern of thinking, I recognized that I had consciously or subconsciously bought into the stereotypes purported by the media about black men. Most media outlets portray black men as violent criminals. The recognition that I bought into this notion was very upsetting. I had considered myself incapable of such sentiments. Thereafter, other prejudice beliefs and feelings that I possess came to the surface. I recognized that I feel a level of anxiety around Arab Americans since the events of September 11th. Again, this underscores my reliance on the media to inform me about people. I was not allowing myself to fully experience individuals from other cultures. I had formed preconceived notions about people based on external influences. The list of prejudice beliefs continued to emerge. I recognized that I believed that Asians were bad drivers and that Mexican Americans tended to be loud. I experienced a great deal of angst regarding these realizations. Just as I suspected, I did feel a tremendous amount of guilt and shame about these feelings. I felt overcome and burdened with these emotions. However, I realized that feeling guilty and ashamed allowed me to avoid contemplation and change. I realized I had to step back and take a closer look at myself as a multicultural being. I had to understand how I saw myself in this world and then how I saw others. It is critical to understand how my own beliefs and feelings impact my current behavior and will influence my future performance as a therapist.

I was able to clarify my own identity through this experience. I had previously identified myself as a Jewish woman. I now consider myself to be a white, Jewish, middle-upper class, heterosexual woman. None of these identifiers are new. I have always been white, heterosexual, and middle-upper class. What has changed is the importance of identifying myself with these qualifiers. This awareness helps me understand my own experiences relative to the experiences of other individuals. I never used to identify myself as Caucasian. I never really considered the implications of being White in this society before this class. The most important notion that I learned in this class is related to this issue. In order to understand the plight of minorities in this country, it is critical to understand the experience of being Caucasian in this country. Being Caucasian affords one the luxury of not considering one’s race. Being White automatically provides one with various privileges that are not granted to non-White members of this society. The White race dominates this country. The infrastructure of America is built around White people and White ideals. Most positions of power are held by White men. The majority of people portrayed on television, in the movies, and in marketing material are White. The majority of products and services offered in this country are geared towards White people. Most academic programs are geared towards White people. Once I recognized this fact, I realized how many privileges I have been afforded due solely to the color of my skin. I also realized how difficult it must be to be a non-White individual in a society in which you are not accurately or regularly represented. I was then able to imagine how I would feel as a minority member of this society. I imagine that I would feel angry and isolated. I imagine that I would feel sad and helpless. I imagine that I would worry about how to raise my children in such a society. I imagine that I would need a great deal of courage and strength to live in this society as a non-White individual. It was only then that I fully recognized how little I have understood about prejudice. Non-White individuals experience prejudice everyday due to the way in which this society is structured around White individuals. Everyday a non-White person must face and deal with this truth. The Invisibility Syndrome article highlights the experiences of African Americans in today’s society. It outlines scenarios in which African Americans are directly or indirectly mistreated due to the color of their skin. In one incident, an African American business man gives his waiter his credit card to pay for a meal. The waiter returned the card to the white patron, assuming the Caucasian man must be the person with the financial power and status. Another account detailed the frustrating and regular occurrence of being followed by security guards in department stores due to one’s minority status (Franklin 1993). It is critical to recognize these truths in order to begin to understand where a non-White individual is coming from. It is not enough to simply not be prejudiced. It is critical to have a conscious awareness of the experience of being a minority in America today. My goal is to always carry this awareness with me in both my personal and professional endeavors.

This goal is not without its challenges and imperfections. I have issues and roadblocks that get in the way of this lofty goal. As previously discussed, I have my own prejudice feelings and beliefs to confront. My tendency is to experience shame and guilt about these feelings. In order to avoid these unpleasant feelings, I may consciously or subconsciously try to avoid facing these issues. This approach would be detrimental to my therapeutic relationships. For example, if I ignore the feelings of irrational fear that I have experienced towards Black men, then I am unable to deal with the source of these beliefs and to change these notions. Additionally, if I avoid these feelings in the context of therapy, I may unintentionally express feelings of fear, anger, or disinterest towards an African American client. It is therefore critical for me to recognize when my own issues or limitations become barriers to intercultural work (Harrell 2000). This awareness will prompt me to work on my own issues that could impact the process. Another source of countertransference could derive from the fear that a non-White client will be angry at me because I am White. As a result, I may become defensive or experience shame and guilt related to this possibility. It is important that I do not have any preconceived notions about my clients’ beliefs and feelings. Additionally, it is critical that I learn how to deal with potential feelings of anger from a non-White client related to racial issues. It will be important to show empathy and to express validation for these feelings while not allowing them to impede the therapeutic process. I believe this represents an area of challenge for me due to my feelings of guilt and shame. I have experienced a tremendous amount of guilt associated with the issues I have explored in this class. Fully realizing the extent to which I am afforded privileges solely due to the color of my skin makes me feel ashamed. I feel ashamed that life is easier for me in this society because I am Caucasian. I feel ashamed that this society is set up to oppress non-White individuals. The guilt is related, in part, to my feelings of helplessness. I am unsure about what I can do to make a difference. The best I have come up with is to actively enhance my awareness about the experience of others. Additionally, I have begun to educate friends and family about my own revelations. This sharing has resulted in an increased awareness of these issues amongst my social network. This increased awareness is a positive occurrence. It would be detrimental to allow my guilt and shame to facilitate avoidance of actively thinking about this issue. My challenge is to maintain a keen level of awareness about this issue and to avoid giving in to feelings of helplessness. Giving in to such feelings facilitates passivity. Passivity allows avoidance of the complexity and unpleasantness associated with these issues. Passivity allows avoidance of action and change.

It will be incumbent upon me to learn as much as I can about my minority clients. It will be critical to understand their cultures, families, and perspectives about mental illness and mental health services. Several ways to achieve this level of knowledge include seeking out experiences to enrich my cultural perspective of a minority client, learning about the individual worldview of each client, assessing the extent to which a client has experienced difficulties related to ethnicity, and learning about the role of family in the client’s life (Erickson 2001). It is extremely important to understand the worldview of all clients, particularly minority clients. I view this understanding as a critical portion of the therapeutic process with a minority client. As a therapist, I also view it as an extremely challenging process. It can be uncomfortable and anxiety provoking to introduce the issue of race and ethnicity in the therapeutic process. However, I need to be willing to take risks with my clients in this regard. When in doubt about the importance of race and ethnicity in treatment, I should err on the side of discussion (Cardemil 2003). This requires an ability to establish a solid therapeutic alliance in order to facilitate an environment in which the client can speak freely about their worldview. This worldview of a minority client will be shaped by an individual’s history and current experiences in this country as a minority. It is important to consider the impact of adverse social, environmental, and political factors in assessing problems and designing interventions (Affairs 1993). This is especially challenging as a White therapist. The client may believe that I am unable to understand their perspective as an individual who is part of the dominant culture. My job is to somehow communicate empathy and understanding to the client. My job is to create a rapport that allows the client to believe that I can be helpful in spite of my status as a White individual. This poses a serious and critical challenge. I will continue to prepare myself for this challenge by maintaining a constant awareness of the experiences of White and non-White people in this society. I will continue to facilitate dialogue amongst my professors, classmates, friends, and family about this issue. I will consult with minority and non-minority colleagues and friends to discuss the best way to reflect understanding and empathy in the context of this kind of therapeutic relationship. I will continue to work on my own feelings of prejudice in order to shift my mindset and behavior. I will also work on coping with my feelings of guilt and shame associated with my status in this society. This energy would be better spent on enhancing my awareness of the experiences of my clients.


Affairs, A. O. o. E. M. (1993). "Guidelines for providers of psychological services to ethnic, linguistic, and culturally diverse populations." American Psychologist 48(1): 45-48.

Becker, C., Chasin, L., Chasin, R., Herzig, M., & Roth, S. (1995). Cultural resistance: Challenging beliefs about men, women, and therapy, The Haworth Press, Inc.

Berry, J. W. (1998). Acculturative Stress. New York, Routledge.

Cardemil, E. V., & Battle, C.L. (2003). "Guess who's coming to therapy? Getting comfortable with conversations about race and ethnicity in psychotherapy." Professional Psychology: Research and Practice 34(3): 278-286.

Erickson, C. D. (2001). "Providing Health Services to Arab Americans: Recommendations and considerations." Cultural Diversity and Ethnic Minority Psychology 7(4): 308-327.

Franklin, A. J. (1993). "The invisibility syndrome." Networker: 33-39.

Garcia-Preto, N. (1996). Readings in ethnic psychology. New York, Routledge.

Harrell, S. P. (2000). "A multidimensional conceptualization of racism-related stress: Implications for the well being of people of color." American Journal of Orthopsychiatry 70(1): 42-57.

Langman, P. F. (1999). Jewish issues in multiculturalism: A handbook for educators and clinicians. Northvale, NJ, Jason Aronson.

Lannert, J. L. (1991). "Resistance of countertransference issues with spiritual and religious clients." Journal of Humanistic Psychology 31(4): 68-76.

Ridley, C. R. (1995). Overcoming unintentional racism in counseling and therapy: A practitioner's guide to intentional intervention. Thousand Oaks, CA, Sage.

Scher, M. (1990). "Effect of gender role incongruities on men's experience as clients in psychotherapy." Psychotherapy 27(3): 322-326.

Visit the author at:

comments powered by Disqus