Cultural Assessment

Knowledge of a client’s culture is necessary to increase a health care provider’s cultural sensitivity. However, this knowledge is not sufficient for developing an effective psychosocial assessment. Although learning about other cultures serves as an excellent starting point, one must also perform a “cultural assessment” to determine the full range and extent of cultural issues facing a client. Just because a client is of a particular race or ethnicity does not necessarily mean that he or she will identify with the group’s culture in its entirety, or even at all. Most individuals will fall somewhere in between the two ends of this extensive spectrum. It is important to regard each person as an individual and avoid stereotyping. Client self-report is the most reliable source of information on the relevance of particular cultural factors (Rodriguez & Walls, 2000).

►Exercise

There are numerous cultural influences and values you might explore during a psychosocial assessment. What cultural influences and values do you typically explore? Each of the following cultural influences and values may be important to explore with specific clients under specific circumstances. Think of an open-ended question for each topic that might help determine how important it is to a client.

____ Language and communication process

____ Cultural habits, customs, beliefs

____ Country of origin

____ Migration or relocation experience

____ Degree of acculturation

____ Importance and impact associated with physical characteristics

____ Emotionality

____ Decision-making processes

____ Influence of spirituality/religion/belief system

____ Perceived cause of the problem

____ Perceived consequences of the problem

____ Help-seeking behavior

____ Family relationships

____ View of self vs. group

____ Support systems

____ Intergenerational family issues

____ Roles for males and females

____ Feelings of guilt

____ Feelings of shame

If you had to choose, which three topics would be most important to address in this case? Why?

Guilt and Shame

Guilt and shame are often intense emotions. The genetic counselor may suspect that the members of this couple are experiencing one or both of these emotions. Guilt is focused on external judgment where the client is concerned about retribution and threats from outside forces (“God is angry at me because I didn’t pray enough”). Shame is focused on the client’s feelings of internal failure (“I am worthless. I don’t deserve to have a perfect baby”). Identifying the emotion being expressed by the client is important for implementing appropriate counseling. Role playing may be useful for facilitating this exploration, as well as to help clients better understand their partner’s emotions. For guilt, use of authority, normalization, reframing, and limiting liability may be useful counseling strategies. For shame, reframing, and limiting liability may be useful. Readers should study the following resources for in-depth exploration and application of these interventions in genetic counseling: Kessler, S., Kessler, H. & Ward, P. (1984). Psychological aspects of genetic counseling. III. Management of guilt and shame. Am J Med Genet, 17, 673-697; and Weil, 2000, pp. 69-79.

Role Playing

Role playing is a technique in which participants pretend they are coping with a specific person or situation and play-act or rehearse different approaches and solutions (Resta, 2000). Role play participants can test behaviors and decisions in an experimental atmosphere without risking negative effects in a relationship (Shearer et al., 2001). Analysis of the interaction provides an opportunity to express feelings, increase observational skills, provide rationale for possible behaviors, critique interventions, and suggest and explore new behaviors before an actual interaction occurs (Lowenstein, 2001; Shearer et al., 2001). Role play is a strategy that has been used to develop cultural competency as it also allows participants to experience diverse roles, share attitudes or behaviors, and increase cultural diversity awareness.

►Exercise

Work with two other participants to role play the psychosocial assessment and support portion of this case scenario in a culturally sensitive manner. Take turns playing the role of each of the three participants: Michele the genetic counselor, Yunhua, and Biao. As the counselor, try to address the three most important cultural concerns you determined in the previous assessment exercise. Ask questions to elicit information and respond in a supportive and empathetic manner. Consider how you can convey respect for the couple’s values and perspectives.

Time frame: Spend 15-20 minutes playing each role and at least 5 minutes analyzing each role play.

Analysis:

If several people were able to play the counselor, what similarities and differences were seen in their “top three” most important cultural concerns?

How did the counselor elicit information in a respectful and culturally sensitive manner?
How did the counselor elicit a comprehensive cultural assessment of the couple for the chosen concerns?
How did the counselor’s responses demonstrate understanding of the couple’s position?
What approaches to the situation were the most fruitful?
Were any of the counselor’s approaches counterproductive, and if so, why?
Did any tensions feel irresolvable?
What other issues emerged during your role play that needed to be addressed?
How could you better perform a psychosocial assessment and provide support in this type of situation?
Describe your emotions.
Did any of your personal emotions help you be more, or less, attentive and effective with this client?
Which emotions were more likely due to the counselor’s unconscious or conscious countertransference reactions to the emotions expressed by the client, to the clinical situation, or to other personal thoughts or experiences of the counselor? Which emotions can be attributed to the “reality of the client’s personality and behavior”? (Weil, 2000, p. 86).

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