The Influence of Culture on the Practice of Professional Counselling

Preamble

Culture is the core of internal ways in which human beings develop their sense of self, including values, beliefs, thought patterns, perceptions, and worldviews. All these qualities help determine and shape one’s external culture - the ways in which one establishes and maintains a relationship with the environment and others through implicit norms, language, traditions, rituals, and loyalties that influence attitudes, behaviors, and customs (Gushue, 1993). While it is true that Singapore is a mix of different ethnic groups, each group has retained much of its individual unique cultural character. This is because Singapore’s policy has always been geared towards multiculturalism, where every ethnic group is allowed to preserve its own culture while peacefully interacting with others. In the light of this, counselling and intervention is always presented within the cultural context and constraints inherent in our cosmopolitan society. The understanding of a client’s unique culture is necessary in order for a counsellor to effectively help the former behave and feel differently in a trusting relationship so as to achieve their goals.

This paper is a qualitative inquiry by the research group to explore the impact of culture during our training as counsellors. The following discussion includes our views on the importance of cultural influence in our counselling work, our personal values, prejudices and motives for helping people as well as our worldviews as a major ethnic group. As we identify various cultural issues encountered when applying western counselling models in the Singaporean context, our constructivist’s approach would be to unlearn our negative cultural conditioning, and re-construct and adopt more meaningful models. The benefits of a multicultural perspective would be examined and ideas on ways to acquire greater multicultural counselling competency would be presented.

Methodology

In the social sciences, qualitative research is often a broad term describing an in-depth research that focuses on how individuals and groups understand the world and construct meaning out of their experiences and the reasons that govern it. The why and how of decision-making will be investigated. It is essentially narrative-oriented and uses the methods of content analysis. The researchers are explicitly a part of the data gathering process. The need is for smaller but focused samples to make meaning of culture in their counselling practice. (Retrieved from http://en.wikipedia.org/wiki/Qualitative_research#References on 12th September, 2006.)

Our group of six members met once before the workshop to make sense of the research project handouts we received earlier. During the workshop, we formulated a questionnaire (included as Appendix A) to be responded individually by members of the group. At subsequent meetings, we presented our individual responses (data) in transcripts. The process of open coding, axial coding and selective coding (Neuman, 1997) were adopted.

In open coding, the individuals’ transcripts were scrutinized for common and salient points. They were highlighted using colored code labels for themes that emerged. For axial coding, connections between categories and sub-categories of the earlier coded themes were derived. In so doing, we expanded our knowledge of the categories and identified the axis of key concepts. Finally, in selective coding, we revisited the data and earlier codes to analyze and elicit further evidence to validate and support the major themes.


Key Dimensions of the Group


Gender M F F F F F
Age 53 53 45 37 30 48
Race Chinese Chinese Chinese Chinese Chinese Chinese
Religion F/Thinker X'tian X'tian Catholic X'tian X'tian
M/Status Married Divorced Married Married Single Married
Academic MBA BSc (Hons) Diploma BBA BSc Diploma
OccupationManagerAdministratorRealtorDirectorProgram ExecutiveCourt Volunteer
(Figure 1)

As can be seen in (Figure 1), our group is quite homogenous with similar demographic profile. All are of Chinese decent; therefore belongs to the dominant ethnic group in Singapore. Majority are Christians, professional and bilingual, i.e., English and Mandarin speaking. Age and academic qualification are the prominent diversities in the group. By and large we share similar cultural heritage in the Chinese community.

Participants’ Perspectives

There is a group consensus that culture is an important component of counselling as Magdalene puts it:
Culture moulds one’s identity which is expressed in terms of core belief, value system and thought processes. The ability of the counsellor to connect with the client at his core beliefs, value and thought processes would determine the level of bonding in this helping relationship. The counsellor’s level of sensitivity towards the client’s cultural identity has an impact on the counselling process and its success thereafter.

According to Juliet:
In diagnosis, psychological judgments are never free from the influence of therapist’s own cultural values. In intervention, counsellors need to be knowledgeable of the culture of their clients because each culture holds different ideas about what constitutes problems in living.

As we have grown up in a cosmopolitan environment, we are immersed in various orientations of different ethnic groups. Our awareness of our own culture only increases when we go to places where our culture is not the norm. Similarly in a counselling room, when we are with our client from a different culture, our awareness of our own culture tends to increase too. We are aware too of the diversity existing within the same culture as people may communicate and interact in a whole range of ways.

Our worldviews as ethnic majority are highly correlated with cultural upbringing and life experiences. There is a tendency to take for granted that the ethnic minority has full knowledge of our culture since it is pervasive in the society. On the other hand, some of us harbor tinted views of the ethnic minority that cause us to unwittingly impose upon them stereotypes and preconceived notions. Annie shared her notion: ‘It is typical of Indian men to drink and abuse their spouses.’

Jennifer shared on what being sensitive to ethnic differences entails:
My sensitivity includes respect and acceptance of who they are, the way they are and their beliefs. I choose to treat people of the minority race fairly and equally. I do not feel the need to treat them with sympathy; otherwise, it would only remind them that they are being differentiated. I learned from my Indian and Malay friends at school about their feelings as minority races in Singapore and that they prefer to be seen as equals.

To be more effective counsellors, we have to first examine ourselves or be aware of our personal values, beliefs, prejudices and motives for helping people. For instance, Peter’s own cultural beliefs that men should be stronger and be able to take on the world and solve their problems rationally and efficiently make him more sympathetic toward his female clients. While some of us in the group who are Christians may be motivated by the teaching of Christ and our spiritual conviction to help people, Peter has this to say, ‘My motives for helping people is firstly for some sort of spiritual maturation. It is my way of building a better world for the future.’

On the whole, there is a recognizable appreciation of our own culture in our group. The curiosity to explore the deeper meaning of our own cultural behavior will certainly enlighten and make us more sensitive to the differences or similarities existing in different cultural groups. ‘A wise counsellor would always try to transcend such barriers and enter into the frame of reference of his client and operate from there.’ (Yeo, 1993)

The first theme that emerged was therefore
the need to be self-aware
as we approach clients from different cultures.

Common Cultural Challenges

The clients we see include students from as young as 6 years old, elderly patients at Nursing Homes/hospital. We also have couples with marital, family and financial issues. Their age group ranges from early 20s to the 70s. They are a mix of Singaporean Chinese, Malay, Indian and some immigrants. Our clients are mainly from low to average income group with basic education. English and Mandarin are the main languages used. Dialects are used when counselling the elderly folks.

Each member in the group shared both common and unique cultural issues they face in counselling. The sexism issue Annie regularly encounters involves female victims of domestic violence in Indian family whose men predominate in positions of power. Most oppressed Indian women inevitably choose not to react for fear of being ostracized by their own family and community. According to Yeo (1989), Asian derives their identity from membership in a family and a community and focusing on the individual might well alienate the person from the family.

Peter and Juliet shared about the common gender issue where parents think they must stay with sons only, while conflicts with daughters-in-law are common issues too. Some parents choose to stay on their own to avoid humiliating their sons. Medical and emotional problems may result from loneliness, poor self care and diet.

Jennifer related her early experience:
I’ve encountered difficulties on many occasions with clients of a different race, particularly Malay clients, in dealing with issues on pregnancy crisis. My early impression was that they were either not willing to share nor receptive to explore other options and alternatives pertaining to their decision to terminate their pregnancy. The session became more fruitful only after I acquired greater understanding of the Malay culture.

For Magdalene, while she is competent in conversational skills with some dialects, attempting to apply counselling techniques or skills present a real challenge. Majority of the counselling approaches are western in origin. The concepts and explanation are all in English. It is easy to miss the deeper nuances when she attempts to apply or translate them into dialect or language which she is not fully competent in.

Both Magdalene and Ruth observed that it is culturally the norm of the older generation to attribute crisis to some external causes and to seek help from temple mediums. The words of the mediums will then be accepted as truth. It can be a real challenge to counsellors from a different faith.

Ruth, the youngest member in our group, perceives age as a stumbling block to effective counselling when her clients are much older. In the Asian context, age is a sign of maturity and wisdom. With elderly clients, we are expected to show respect and humility, not as someone to solve their problems.

Annie faced the social-economic issue when she encountered Singaporean men who resorted to increase their socio-economic status by taking wives from the poorer ASEAN countries. The wives function more as domestic helpers or care providers to the elderly/invalid parents or young nephews and nieces within the extended family. The relationship is further strained by language barrier and other cultural issues.

Western Counselling Models in Singaporean Context

The group is pragmatic in our counselling approach, integrating different therapy models to meet the client’s unique needs. With cross-cultural interaction comes the possibility that the client’s intentions and actions may be misperceived, misinterpreted, and misjudged notably, when we employ the western counselling models on culturally different clients. We are aware that some of these models may not even fit people from western cultures due to within-culture diversity and other diversity factors beyond culture. (Egan, 2005)

The second theme that emerged was the need to understand the worldview of culturally different clients in order to know how best to
integrate the western counselling models in our counselling work.

Magdalene commented that the concept of individuation in Bowen Theory is culturally not in tandem with many elderly Chinese clients, who come from an environment where the family, community, or clan takes precedent over self; hence differentiation of self can be alien to them.

A person’s identity is formed and continually influenced by his or her context. Working effectively with clients requires an understanding of how the individual is embedded in the family, which in turn requires an understanding of how the family is affected by its place in a pluralistic culture. (Sue, Ivey & Pedersen, 1996).

Bowen Theory encourages the therapist to look into the Family of Origin to examine the interlocking relationships. This can present itself negatively as in-laws or family members may not be forthcoming when it comes to talking about sensitive and conflicting issues inflicting the family. Juliet presumed Bowen Theory will be better understood and accepted by the English-educated clients, but she found out to her dismay that some concepts contradict their cultural beliefs.

Peter found Rational-Emotive Behavioral Therapy (REBT) to be too confrontational in style. Telling a client that he is “horriblising” and “catastrophising” his life issues when he is seeking understanding from a counsellor in his moments of anxiety is not going to be welcomed. Asians generally seek familial help when they have problems. The concept of going to a counsellor who is a stranger is already a major deviation from their social norms. Facing a challenging counsellor may pose as a humiliating experience for some.

Annie’s observation:
Solution-focused Brief Therapy (SFBT) focuses on what clients want to achieve through therapy rather than on the problem(s) that made them seek help. The approach does not focus on the past, but on the present and future instead. This goes down well with the clients she sees who are pragmatic and time-conscious.

However, Magdalene observed that asking the miracle question to a pragmatic elderly client may pose a challenge. Some of them have mindsets that have been deeply entrenched in their being; they do not see the need to change. Similarly, to challenge the Irrational Beliefs (Cognitive Behavioral Therapy) of the elderly whose sense of self has been conditioned to adopt a resigned disposition can be an uphill task.

The use of `hot-seat’ fantasy technique to help clients express their feelings where there is unfinished business may not be favored by the more ‘conservative and traditional’ clients as unleashing negative emotions towards the deceased is considered a taboo.

Magdalene related her encounter:
Using Gestalt approach, I encouraged him to imagine that the mother was present at the moment, and for him to tell her what was on his mind. He responded, ‘she is already dead, what is there to say?’ I realized later that while he might be bad mouthing and blaming her for his current plight, it was culturally not appropriate for him to confront her.

Ruth felt incompetent when she encountered elderly people who often interrupted her during conversation to correct her. Her age and lack of knowledge in dialects made it difficult for her to express herself aptly. But she found Carl Roger’s Person-Centered therapy useful when working with clients who question her abilities.

Multi-cultural Competencies

The challenges we face as counsellors in a multicultural environment require that we know and understand the client’s culture so as to be congruent with the frame of the world that the client is in during counselling, i.e., individuals are best understood by taking into consideration salient cultural and environmental variables. Regardless of the therapist’s orientation, it is crucial to listen to the clients and determine why they are seeking help and how best to deliver the help that is appropriate for them. (Corey, 1996) In this pluralistic and post-modern age, no one helping approach has all the answers for the clients we see due to the complexity of human beings, as expressed by Sue, Ivey and Pedersen (1996).

The third theme that emerged was the need for therapists to create therapeutic strategies that are congruent with the range of values and behaviours
that are characteristic of a pluralistic society.

Jennifer had this to say:
Without a deeper understanding of the Malay culture and religion, my counselling sessions with the Malays would certainly be unfruitful. There are family and social pressure to learn within the context of religion and culture. The Malay clients who are pregnant out of wedlock find themselves opting for abortion as the only way to avoid violating family tradition. I have to work on interventions that are congruent with the values of the clients.

It is a sign of respect that counsellor refrains from deciding what behaviour should be changed. Through skilful questioning on the counsellor’s part, ethnic minority clients can be helped.

The process of internalizing a new culture is an on-going undertaking. Generally the group is willing to be exposed to all kinds of clients so as to open up our own world views of the different cultures in our society. This includes interacting with people of different races at social events and festive celebrations. We recognized that with the culturally-constraint client we have to go slow during the first counselling session. The clients can be invited to teach the therapists about the significant parts of their cultural identity.

We all acknowledged the importance of supervision and guidance when we are unsure and need clarification. We also will be seen as more professional if we master the basic terminologies of counselling approaches in other languages/dialects.

Having an enquiring and inquisitive mind about the different cultures will help broaden our perspectives. Formal education on the multicultural aspects of counselling will help to hone our skills. We can also gain insights by reading articles and books related to multicultural counselling. There are hefty handbooks offering the theoretical background, practical knowledge, and training strategies needed to achieve multicultural competence. (Pope-Davis, Coleman, Liu, & Toporek, 2004). In addition, there are highly detailed research studies offering further insights in multicultural competence. (Darcy, Lee, & Tracey, 2004). The greater our depth and breadth of knowledge of culturally diverse groups, the more we can be effective practitioners (Corey, 2001).


Conclusion

In summary, the qualitative inquiry has promoted self-awareness of our own personal culture as we develop a sense of the world. Courage, openness and humility are some important elements we identified to secure trust and acceptance by our clients of different cultures. Our group will certainly strive to integrate appropriate counselling approaches to create therapeutic strategies that are congruent with the client’s range of values and behaviours, without abdicating our own deepest beliefs and values.
(2,991 words)


Appendix A

Questionnaire

1. What kinds of people do you see in your practice?

2. What are some common cultural issues that you face in your
counselling?

3. What kinds of issues can you identify in applying western
counselling models in the Singaporean context?

4. What are the difficulties that you find in working with clients
from a different culture? You may illustrate with a case.

5. What are some of the ways you adopt during counselling to effectively
overcome the difficulties you find working with clients mentioned in question 4.

6. How has your multi-cultural perspective benefited you in your
counselling work?

7. What would you do about your training as a counsellor to acquire greater
multicultural counselling competency?
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