Charli Wheeler
Capella University
Psychology Capstone PSYC-FPX4900
Ruhama Hazout
September 2023
Cultural Sensitivity in Practice: A Case Analysis of Hannah and Adara
The case in focus presents a multifaceted scenario involving Hannah, an African American school counselor, and Adara, a 15-year-old Muslim-American student. Adara, experiencing feelings of isolation and cultural difference in her school environment, approached Hannah for guidance. These feelings were further intensified by Adara’s suicidal ideation, a critical aspect that demanded immediate attention.
Hannah, recognizing the severity of Adara’s emotional state, recommended professional therapeutic intervention. However, Adara was hesitant, believing her parents would not endorse such a course of action. This dynamic took a challenging turn when Hannah, prioritizing Adara’s safety, informed Adara’s parents about her suicidal thoughts. This decision, while made with Adara’s well-being in mind, led to feelings of betrayal and a perceived breach of trust.
Psychological theories can offer insights into the underlying factors contributing to Adara’s feelings and the subsequent challenges in her interactions with Hannah. Additionally, empirical research provides a foundation for understanding and potentially addressing such complex situations.
This case emphasizes the intricate balance professionals must maintain between cultural sensitivity, ethical responsibilities, and the practical demands of their roles. As the demographic landscape of the U.S. evolves, the need for nuanced understanding and cultural competence in professional interactions becomes increasingly paramount.
Cultural Issues
The Hays’s ADDRESSING Model, developed by Dr. Pamela Hays, offers a comprehensive framework to understand the multifaceted cultural identities that individuals possess. This model emphasizes ten major factors of cultural difference, highlighting the power dynamics associated with each factor in the context of the United States (Lenart, 2009). In the case of Adara, several of these cultural factors come into play, impacting her experiences and interactions.
Age (A): Adara’s age places her in the challenging phase of adolescence, a period marked by identity formation, peer influence, and the quest for autonomy. As a minor, she is subject to certain legal and ethical considerations, especially in the context of her expressed suicidal ideation. Hannah’s obligation to inform Adara’s parents due to her age and potential self-harm risk underscores the power dynamics between adults and adolescents.
Religion (R): Adara’s Muslim faith is a significant aspect of her identity. In a predominantly Christian society, her religious practices, especially wearing a headscarf, set her apart. This distinction has made her a target for derogatory remarks, intensifying her feelings of isolation and otherness.
Ethnicity (E): Adara’s Iraqi descent adds another layer to her identity. Being a person of color in a predominantly Euro-American environment can lead to feelings of exclusion. The cultural practices and traditions associated with her ethnicity further contribute to her sense of difference.
Nationality (N): Adara’s family’s immigrant background from Iraq presents its own set of challenges. Immigrants often grapple with the dual pressures of assimilation and preserving their cultural heritage. For Adara, being of Iraqi descent in post-9/11 America adds an additional layer of complexity. The societal perceptions, stereotypes, and biases associated with Iraq, especially in the aftermath of 9/11 and the subsequent wars, can lead to heightened feelings of exclusion and prejudice. Adara’s experiences reflect the intricacies faced by many immigrants, especially those from regions that have been politically and socially contentious in the American context.
Gender (G): As a young female, Adara encounters societal views and stereotypes associated with Muslim women. Gender dynamics, especially in the context of cultural and religious practices, can influence how individuals navigate their environments.
In understanding Adara’s experiences through the lens of the ADDRESSING Model, it becomes evident that multiple cultural factors intersect, shaping her interactions and perceptions. Recognizing and addressing these factors is crucial for professionals to provide sensitive and effective support.
Theoretical Explanations
To understand the cultural and psychosocial issues faced by Adara, it’s essential to apply relevant psychological theories. Two theories that offer profound insights into Adara’s situation are Erik Erikson’s Psychosocial Development Theory and Urie Bronfenbrenner’s Ecological Systems Theory.
Erik Erikson’s Psychosocial Development Theory
Erikson’s theory posits that individuals go through various stages of psychosocial development, each characterized by a specific conflict (Faila, Latipah, & Izzah, 2023). For Adara, who is in her adolescence, the relevant stage is “Identity vs. Role Confusion.” This stage is crucial for developing a sense of self and personal identity. The challenges Adara faces, such as feeling “different” and experiencing bullying due to her cultural and religious background, can hinder her journey in establishing a robust personal identity. The feelings of isolation and the struggle to fit in resonate with Erikson’s assertion that failure to establish an identity can lead to role confusion and a weakened sense of self (Juroszek, 2023).
Bronfenbrenner’s Ecological Systems Theory
Bronfenbrenner’s Ecological Systems Theory emphasizes the importance of understanding an individual within the context of various environmental systems (Nurul Amirah et al., 2023). Adara’s experiences can be analyzed through multiple layers of this theory.
The microsystem is the immediate environment in which Adara interacts, such as her school and family. The bullying she faces at school and her interactions with Hannah fall into this layer.
The mesosystem involves the interconnections between the various microsystems, like the relationship dynamics between Adara’s school environment and her family life, especially after Hannah’s disclosure to her parents.
The exosystem layer encompasses factors that indirectly influence Adara, such as her parents’ experiences and perceptions as immigrants from Iraq. Given the post-9/11 sentiments and the subsequent war, their background might shape how Adara is perceived in her community (Sin Wang Chong, Isaacs, & McKinley, 2022).
Finally, the macrosystem layer refers to the broader societal beliefs and customs. The general perceptions and stereotypes about Muslim-Americans in society fall into this layer, influencing how Adara is treated by her peers and society at large.
Incorporating Bronfenbrenner’s theory provides a comprehensive understanding of the multiple layers of environmental influences on Adara’s experiences. It underscores the importance of considering both individual developmental stages and the broader environmental context when addressing her challenges.
Professional Behaviors
The case of Hannah and Adara presents a complex interplay of cultural, ethnic, and age-related factors that influence professional behaviors and decisions. A significant issue that emerges is Hannah’s decision to inform Adara’s parents about her suicidal ideation. While this action was rooted in a genuine concern for Adara’s safety, it also highlights the challenges of cultural sensitivity and confidentiality. In many cultures, discussions around mental health are stigmatized, and the idea of seeking therapy might be met with skepticism or disapproval. Adara’s reluctance to see a therapist, believing her parents would disapprove, underscores this cultural challenge. Although ethically and legally obligated to ensure Adara’s safety, Hannah’s decision could be perceived by Adara as a breach of trust and a potential oversight in cultural sensitivity.
Adara’s age also plays a crucial role in this dynamic. As a minor, she might not fully understand the professional obligations that Hannah has, especially when it comes to ensuring the safety of her clients. Adara’s statement, “Doesn’t she have to keep what I say to herself?” indicates a potential gap in her understanding of the boundaries of confidentiality. This highlights the importance of professionals like Hannah setting clear expectations about confidentiality and privacy rules at the outset of their interactions, especially with younger clients.
Furthermore, Adara’s experiences of being unjustly labeled a “terrorist” and the subsequent bullying she faces both online and offline emphasize the persistent stereotypes associated with Muslim-Americans, especially in the post-9/11 context. Such biases, even if not held by professionals, can shape the broader environment in which they operate. Professionals must remain vigilant, ensuring that societal stereotypes or biases do not inadvertently influence their decisions.
The headscarf Adara wears, symbolic of her religious and cultural identity, becomes a point of differentiation in her school environment. Professionals need to recognize the significance of such practices and the challenges they can present. Trust is foundational in any professional-client relationship. Adara’s feelings of betrayal after Hannah’s disclosure to her parents signal a potential erosion of this trust. Striking a balance between ensuring a client’s safety and maintaining their trust becomes even more nuanced when cultural and age-related factors are at play. It’s clear that professionals, despite their best intentions, face multifaceted challenges that require continuous learning, self-reflection, and a deep commitment to understanding.
Research Findings
Therapeutic Relationship with Minors
The therapeutic relationship between a counselor and a minor is a delicate balance of trust, confidentiality, and the ethical duty to ensure the safety of the minor. Lazovsky (2008) explored the challenges therapists face when working with minors, particularly around issues of confidentiality. The study emphasized the importance of clear communication about the boundaries of confidentiality at the outset of therapy. This is especially pertinent in Adara’s case, where she felt her trust was violated when Hannah informed her parents about her suicidal ideation. Another study by Ford (1997) highlighted the influence of physician assurances of confidentiality on adolescent patients. The findings suggest that adolescents are more likely to disclose sensitive information when they are assured of confidentiality. This underscores the importance of Hannah being transparent with Adara about the limits of confidentiality, especially given the serious nature of Adara’s disclosures.
Experience of Muslim-Americans in Post 9/11 America
The experience of Muslim-Americans, especially post 9/11, is characterized by increased scrutiny, prejudice, and discrimination. Tindongan (2011) conducted a study that delved into the identity negotiation of Muslim youth in a post-9/11 U.S. The findings revealed that Muslim youth often grapple with dual identities, trying to fit into both their American environment and their religious and cultural heritage. This duality can lead to feelings of isolation, especially when faced with prejudice or discrimination. Khan and Ecklund (2013) examined the attitudes toward Muslim Americans post-9/11. The research found that Muslim-Americans, especially those who are visibly identifiable as Muslims, like Adara with her headscarf, often face heightened prejudice and are sometimes labeled as “terrorists,” which aligns with Adara’s experiences of bullying and feeling “different.”
Mental Health Stigma in Different Cultures
Mental health stigma, particularly in diverse cultural contexts, can significantly influence an individual’s willingness to seek help and discuss their mental health concerns. Amri and Bemak (2013) explored the mental health help-seeking behaviors of Muslim immigrants in the U.S., emphasizing the role of social stigma and cultural mistrust. The study highlighted that cultural factors, religious beliefs, and lack of knowledge about mental health often contribute to negative perceptions about mental disorders and treatments. Similarly, Ciftci, Jones, and Corrigan (2013) delved into the mental health stigma within the Muslim community. The research emphasized the role of traditional and religious beliefs in shaping perceptions about mental health. In many Muslim communities, mental health issues are often attributed to supernatural causes, and there’s a preference for traditional healing methods over Western psychiatric treatments. This cultural context might shed light on Adara’s hesitancy to discuss therapy with her parents and her anger at Hannah for breaching her trust.
Proposed Cultural Guidelines and Competencies
Cultural Competencies for Resolving the Issue
In addressing the multifaceted challenges presented in the case study, a psychologist like Hannah must be equipped with a range of cultural competencies. One of the primary competencies is a deep understanding of the Muslim-American identity, especially in the context of post 9/11 America. Given the unique challenges faced by Muslim-Americans, particularly young individuals like Adara, it is crucial for psychologists to be aware of the potential prejudices, stereotypes, and biases that this community often confronts. This knowledge not only aids in building trust but also in tailoring interventions that are culturally sensitive and effective.
Adolescence, as a developmental phase, brings its own set of challenges. When cultural and religious identity complexities intersect with the typical struggles of adolescence, the challenges can amplify. Recognizing the dual struggle Adara faces—as a teenager and as a Muslim-American in a predominantly non-Muslim environment—is essential. A culturally competent psychologist would validate Adara’s feelings of being “different” and provide support strategies that respect her cultural background while addressing her mental health concerns.
Furthermore, the therapeutic relationship’s foundation rests on trust, making clear communication about confidentiality paramount, especially when working with minors. Adolescents, in their quest for autonomy, often seek spaces where they can express themselves without fear of judgment or repercussions. However, they might not fully grasp the legal and ethical boundaries of confidentiality in therapeutic settings. It’s imperative for psychologists to set clear expectations at the outset of the therapeutic relationship. Hannah should have explicitly informed Adara about the conditions under which confidentiality might be breached, such as when there’s a risk to the client’s safety. By doing so, potential misunderstandings and feelings of betrayal, like those experienced by Adara, can be minimized or avoided.
Incorporating these cultural competencies into practice ensures that the therapeutic space is safe and supportive and respects and acknowledges the diverse identities and challenges that clients bring into the session.
Competencies for a Culturally Diverse Environment
In today’s globalized world, it’s imperative for psychologists to be equipped with the skills and knowledge to work effectively in a culturally diverse environment. Several key competencies are crucial for ensuring that therapy is both effective and respectful.
Cultural humility involves recognizing that every individual has their own unique cultural background and experiences. Psychologists should approach each client as lifelong learners when it comes to understanding diverse cultural perspectives. This humility allows for a more open and non-judgmental therapeutic relationship (Fisher-Borne, Cain, & Martin, 2015).
Active listening is also essential to truly understand clients. This involves not just hearing their words but also picking up on nonverbal cues and emotions behind their words. This skill is particularly important with clients from cultures where direct communication may not be the norm (Ridley, Mendoza, & Kanitz, 1994).
Open-mindedness is another critical competency. Psychologists should try to understand and accept beliefs, values, and practices different from their own without necessarily agreeing with them. Ongoing education and training on cultural diversity also helps ensure psychologists stay current on the latest research and best practices. This could involve workshops, literature reviews, or cultural exchanges (Sue, Arredondo, & McDavis, 1992).
Regular self-reflection helps psychologists develop self-awareness of their own biases and prevent interference in therapy (Sue & Sue, 2012). Adaptability to modify techniques for each client’s unique needs is also key.
Finally, strong advocacy skills may be needed at times to support clients facing discrimination. This could involve liaising with other professionals, institutions or communities on the client’s behalf (Toporek, Lewis, & Crethar, 2009).
By developing and honing these competencies, psychologists can provide optimal care for clients of all cultural, ethnic and religious backgrounds.
Integration of Psychological Principles with Personal Values
As I work towards my bachelor’s degree in psychology, I recognize the importance of intertwining psychological principles with personal values. I aspire to bring a unique set of values, beliefs, and experiences to my future role as a psychologist. Empathy, respect for individual autonomy, and a commitment to lifelong learning are values I prioritize. These values will shape my worldview and guide my interactions with future clients.
When professional guidelines align with personal values, it paves the way for more authentic interactions. Clients are more likely to trust and feel understood by a professional whose actions resonate with their stated values and the broader ethical guidelines of the profession. This alignment fosters a sense of safety and understanding, which is crucial for a therapeutic alliance (American Psychological Association, 2017).
However, achieving this alignment is an ongoing journey. There might be instances where my personal beliefs could diverge from professional guidelines or clients’ values. In such situations, introspection and possibly seeking mentorship or consultation will be essential. This ensures that the quality of care remains consistent and ethically sound.
Cultural sensitivity is another core value I emphasize. This approach acknowledges and respects the diverse cultural backgrounds of clients. It requires future psychologists, like myself, to be aware of their biases and to actively seek to understand the cultural contexts of their clients. By integrating cultural sensitivity with personal values and psychological principles, I aim to ensure my approach is ethical and resonates with clients’ experiences.
Plan for Developing Professional Cultural Sensitivity
As I continue my academic journey in psychology, I recognize the importance of fostering cultural sensitivity. This ongoing commitment requires deliberate actions and continuous growth. I have developed a structured plan to ensure I remain culturally informed and responsive.
One key component is participating in workshops and training sessions that emphasize cultural sensitivity and diversity. My objective is to enroll in at least two such sessions annually, beginning in the upcoming academic semester.
Seeking guidance from seasoned professionals is also important when confronted with culturally complex cases. While I will seek supervision as situations arise, I also intend to establish quarterly consultations with a mentor to proactively discuss potential cultural challenges.
Self-reflection sessions will help me allocate focused time for introspection on client interactions through a cultural lens. My goal is to set aside an hour each month to identify biases and areas for growth.
Immersing myself in diverse literature is another critical piece of the plan. I aim to read at least one relevant book, article or research paper every two months to gain insights into varied cultural perspectives.
Finally, community involvement will provide firsthand exposure to complement academic knowledge. Starting this summer, I plan to dedicate one day per month to volunteer activities that connect me with diverse communities.
By proactively implementing this multifaceted plan, I aim to ensure my professional interactions are rooted in cultural understanding, empathy and respect.
Conclusion
Culture, ethnicity, and diversity have always held a profound significance in my understanding of the world. Celebrating people’s differences and embracing the richness they bring to our shared human experience has been a cornerstone of my beliefs. My attitudes, shaped by my experiences and upbringing, play a pivotal role in how I perceive and interact with the world. As I envision my future professional endeavors, I understand that these attitudes will influence my interactions with clients, colleagues, and the broader community.
While I pride myself on being open-minded and empathetic, I’m also aware that unconscious biases might still exist. The guidelines I’ve developed throughout this assessment serve as a roadmap, guiding me towards culturally sensitive and ethically sound professional behavior. They emphasize the importance of continuous learning, self-reflection, and active engagement with diverse communities and literature.
To further my growth in cultural competencies, I recognize the value of seeking diverse experiences. Immersing myself in varied settings, whether through travel, community service, or professional exchanges, will offer firsthand insights into different cultural dynamics. Engaging in regular discussions on cultural topics with peers and mentors can provide fresh perspectives and challenge my existing beliefs. Additionally, establishing a feedback mechanism in my future practice will be pivotal. Encouraging clients and colleagues to share their thoughts on my cultural responsiveness will help identify areas for improvement.
The journey towards cultural competence is continuous. The world is a rich tapestry of diverse cultures, beliefs, and practices. My commitment is to approach each individual with respect, empathy, and an open heart, ensuring that I provide care that resonates with their unique experiences and needs.
References
Amali, N. A. K., Ridzuan, M. U. M., Rahmat, N. H., Seng, H. Z., & Mustafa, N. C. (2023). Exploring Learning Environment Through Bronfenbrenner’s Ecological Systems Theory. International Journal of Academic Research in Progressive Education and Development, 12(2), 144–162. http://dx.doi.org/10.6007/IJARPED/v12-i2/16516
Amri, S., & Bemak, F. (2013). Mental health help-seeking behaviors of Muslim immigrants in the United States: Overcoming social stigma and cultural mistrust. Journal of Muslim Mental Health, 7(1). https://doi.org/10.3998/jmmh.10381607.0007.104
American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. American Psychological Association. https://www.apa.org/ethics/code
Ciftci, A., Jones, N., & Corrigan, P. W. (2013). Mental health stigma in the muslim community. Journal of Muslim Mental Health, 7(1). https://doi.org/10.3998/jmmh.10381607.0007.102
Chong, S., Isaacs, T., & McKinley, J. (2023). Ecological systems theory and second language research. Language Teaching, 56(3), 333-348.
Ford, C. A. (1997a). Influence of physician confidentiality assurances on adolescents’ willingness to disclose information and seek future health care. JAMA, 278(12), 1029. https://doi.org/10.1001/jama.1997.03550120089044
Ford, C. A. (1997b). Influence of physician confidentiality assurances on adolescents’ willingness to disclose information and seek future health care. JAMA, 278(12), 1029. https://doi.org/10.1001/jama.1997.03550120089044
Lenart, J. (2009). ADDRESSING framework – Understanding the social construct of
power [Blog post]. https://cultureandhealth.wordpress.com/2009/12/29/addressing-
understanding-the-social-construct-of-power
Isaacs, M. L., & Stone, C. (2001). Confidentiality with minors: mental health counselors’ attitudes toward breaching or preserving confidentiality. Journal of Mental Health Counseling, 23(4). https://go.gale.com/ps/i.do?p=AONE&u=googlescholar&id=GALE|A80553853&v=2.1&it=r&sid=AONE&asid=a9ad04aa
Juroszek, W. (2023). A Witold Pilecki as a caring parent model from the Erik Erikson’s theory perspective. Fides Et Ratio Scientific Quarterly, 53 (1), 18-26. https://doi.org/10.34766/fetr.v53il.1168
Khan, M., & Ecklund, K. (2013). Attitudes toward Muslim Americans post-9/11. Journal of Muslim Mental Health, 7(1). https://doi.org/10.3998/jmmh.10381607.0007.101
Lazovsky, R. (2008). Maintaining confidentiality with minors: Dilemmas of School Counselors. Professional School Counseling, 11(5), 335–346. https://doi.org/10.5330/psc.n.2010-11.335
Maintaining confidentiality with minors: Dilemmas of School Counselors. (2018). Professional School Counseling, 11(5). https://doi.org/10.1177/2156759×0801100507
Tindongan, C. W. (2011). Negotiating Muslim youth identity in a post-9/11 world. The High School Journal, 95(1), 72–87. https://doi.org/10.1353/hsj.2011.0012