Multicultural Competencies Counseling

Instructor’s Manual
for
MULTICULTURAL
COMPETENCE IN
COUNSELING AND
PSYCHOTHERAPY
with
DERALD WING SUE
Manual by
Shirin Shoai, MA
MULTICULTURAL COMPETENCE IN COUNSELING AND PSYCHOTHERAPY WITH DERALD WING SUE
The Instructor’s Manual accompanies the video Multicultural Competence

in Counseling and Psychotherapy with Derald Wing Sue (Institutional/
Instructor’s Version). Video available at www.psychotherapy.net.
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Shirin Shoai, MA
Multicultural Competence in Counseling and Psychotherapy
with Derald Wing Sue
Cover design by Julie Giles
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Instructor’s Manual for

MULTICULTURAL COMPETENCE IN
COUNSELING AND PSYCHOTHERAPY WITH
DERALD WING SUE
Table of Contents
Tips for Making the Best Use of the Video 4
Sue’s Pioneering Approach to Multicultural Counseling 5
Discussion Questions 7
Role-Plays 10
Reaction Paper Guide for Classrooms and Training 12
Related Websites, Videos and Further Readings 13
Transcript 15
Video Credits 44
Earn Continuing Education Credits for Watching Videos 45
About the Contributors 46
More Psychotherapy.net Videos 47
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Tips for Making the Best Use of the

Video
1. USE THE TRANSCRIPTS
Make notes in the video Transcript for future reference; the next time
you show the video you will have them available. Highlight or notate
key moments in the video to better facilitate discussion during and after
the video.
2. FACILITATE DISCUSSION
Pause the video at different points to elicit viewers’ observations and
reactions to the concepts presented. The Discussion Questions sections
provide ideas about key points that can stimulate rich discussions and
learning.
3. ENCOURAGE SHARING OF OPINIONS

Encourage viewers to voice their opinions. What are viewers’
impressions of what is presented in the interviews?
4. CONDUCT A ROLE-PLAY
The Role-Play sections guide you through exercises you can assign to
your students in the classroom or training session.
5. SUGGEST READINGS TO ENRICH VIDEO MATERIAL

Assign readings from Related Websites, Videos and Further Reading
prior to or after viewing.
6. ASSIGN A REACTION PAPER

See suggestions in the Reaction Paper section.
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Sue’s Pioneering Approach to

Multicultural Counseling*
Derald Wing Sue can truly be described as a pioneer in the field of
multicultural psychology, multicultural education, multicultural
counseling and therapy, and the psychology of racism/antiracism. He
conducted extensive multicultural research and writing in psychology
and education long before the academic community perceived it
favorably, and his theories and concepts have paved the way for a
generation of younger scholars interested in issues of minority mental
health and multicultural psychology. His contributions have forced
the field to seriously question the monocultural knowledge base of its
theories and practices.
Sue’s work advances the idea of traditional therapeutic orientations (i.e.,

classical psychoanalytic, early psychodynamic, and early behavioral)
as being “culture-bound”—namely, originating from a Western, white,
mainstream cultural standpoint that values particular clinical behaviors
over others as well as promoting biased indicators of successful therapy.
For example, clients coming from certain ethnic groups may place value
on the family and collective identity formation; clinicians ignorant
of this fact may unintentionally pathologize this quality, instead
pushing such clients to embrace the more Western value of personal
individuation and differentiation.
Additionally, Sue counts the traditional “blank-slate” stance and

the expectation of client self-reflection among the culture-bound
practices that negate some marginalized groups’ desire for relational
transparency. Self-disclosure and advice-giving are seen as essential
therapeutic interventions among certain cultures, and therefore are
at odds with more traditional counseling approaches. Altogether,
these biased practices have served to alienate minority clients seeking
counseling, leading to underutilization of therapy or early termination.
Sue also cites three levels of identification or experience that white

clinicians, according to his research on white privilege, have tended to
miss: individual, group, and universal. Because whites unknowingly
experience cultural “invisibility”—meaning that “whiteness” is taken
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for granted as a cultural standard, while minority status stands out as a

cultural outlier—group identity exists for minority individuals in a way
that it does not for whites. The “privilege” of invisibility, he maintains,
creates a culture in which whites are not required to consider themselves
as racial beings and leads them to view racial difference only on the
individual (meritocracy, or “we all have the same chance of success,
regardless of race”) or universal (colorblind, or “I don’t see race”) levels.
In contrast, members of marginalized groups, who regularly come into

contact with people of a different background (whether in real life or
in the media), must continually consider themselves as racial beings
and, therefore, experience a group identity formation that is separate
from the other two levels and, if unacknowledged or denied by whites,
is experienced as oppressive. (It is important to note that Sue considers
this oppressive phenomenon to be harmful to whites as well.) Mental
health professionals of any background must understand the nuances
of these three levels, and understand their own place as racial beings
within them, if they are to make genuine cross-cultural connections
with their clients.
In his work at Teachers College, Columbia University, Sue has

designed training programs to support new clinicians in developing
“multicultural competence.” This includes cross-cultural immersion
assignments, consultation and skill-building that integrates
multicultural theory, as well as research into the causes, manifestations,
and impact of racial microaggressions, which refer to the verbal,
behavioral, or environmental indignities—whether intentional or
unintentional, subtle or blatant—that people of color experience in
day-to-day life. These microaggressions, his research shows, not only
produce emotional distress for minorities and people of color, but also
result in inequities in education, employment, and health care. Sue is
currently broadening research on microaggressions to include religion,
gender, disability, sexual orientation, and other marginalized groups.
In this interview, Sue expands on the origins of his research, variances

in race-based experience, and the teaching methods that are becoming
increasingly prevalent in the field. As you watch the video, consider your
own racial or cultural identity and notice what internal responses arise
for you, both intellectual and emotional.
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Discussion Questions
Professors, training directors and facilitators may use some or all of these
discussion questions, depending on what aspects of the video are most
relevant to the audience.
WHAT IS MULTICULTURAL COUNSELING?
1. Cultural competence: What experiences have you had working with
clients from a different cultural background from yours? What
immediately comes to mind when you think of cultural competence
in counseling? As you begin watching the interview, what thoughts
or feelings arise for you? Do you agree with Sue that empathy
isn’t enough to be culturally competent? What are some of your
expectations for learning about this approach?
2. Individuation vs. collectivism: What are your thoughts about
Sue’s assertion that traditional psychological approaches favor
individuation over collectivism? How are these ideas reflected within
your own family? Within your cultural group(s)? Which do you
tend to favor? How might you respond to a therapist who steered you
toward one goal over the other?
3. Generalizations: Do you think Sue is making too broad a
generalization when he describes Asian American cultural values?
Why or why not? How much weight do you place on variations within
cultural groups vs. group differences as a whole?
4. Culture-bound values: Do you agree or disagree that the major
counseling approaches taught today are bound by Western cultural
biases? Why or why not? Do you think a continuum exists regarding
the appropriateness of certain interventions and styles? To what extent
are the approaches you tend to use culture-bound?
5. The role of insight: How much of a class-bound practice do you
consider personal reflection and insight to be? Have you seen
variations in the cultural groups who favor this style of psychological
work? Do you agree with Sue that less affluent populations can only
afford direct solutions and services?
COLORBLINDNESS
6. Cultural sensitivity: Have you named or been made aware of cultural
differences in your work with clients? If so, how did you handle it?
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Can you think of contexts in which naming racial difference might be

off-putting to a client?
7. Comfort with race: How comfortable are you discussing racial
difference with clients? Other cultural differences? Are some
differences easier to talk about than others? Why or why not? What do
you believe constitutes a therapeutic conversation about difference?
8. Colorblindedness: What are your responses to Sue’s naming of
colorblindedness as a barrier to a therapeutic alliance? Does this
concept make sense to you? Have you experienced this in your own
work, either as a therapist or a client? As a client, would you want your
therapist to acknowledge your cultural identity? Would you name this
yourself?
9. Three levels of identity: Do you understand Sue’s three levels of
cultural identity? How comfortable are you with talking about group-
level experience? Does this vary based on the people you’re with or the
settings you inhabit? Would you have any reservations about talking
about identity with a client? How might you address this if it arose?
MICROAGGRESSIONS
10. Microaggressions: What role do microaggressions play in your life?
Do you experience them yourself? How have you dealt with them? If
you’re not a member of a marginalized group, does the concept make
sense to you? How might you work with microaggressions within
therapy, either as a client topic or as a relational rupture?
11. White privilege: What thoughts and feelings arise for you around
the notion of white privilege? Do you think members of any cultural
group can experience privilege? If you are white, have you experienced
your racial identity as allowing you certain privileges you may not
have had otherwise? How might white privilege manifest within the
therapeutic relationship?
DEVELOPING CULTURAL COMPETENCE
12. “Normal” behavior: Based on your own cultural values, what
behaviors or life goals are considered normal or abnormal? Do you
agree with these values? How do your beliefs inform your work as a
therapist? Do your ideas about normal behavior ever contrast with
what you’ve learned in your psychological training? How do you
handle this clinically?
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13. Self-disclosure: To what extent do you use self-disclosure with your

clients? How do you decide when this is or isn’t appropriate? Can you
see this potentially impacting clients from different backgrounds in
ways that would invite discussion or clarification?
THE RACE LAB
14. Experiential immersion: What do you think of Sue’s Race Lab?
Would you want to participate? Why or why not? Have you ever
intentionally immersed yourself in a different culture for a period of
time? What was the experience like for you? How did members of the
group respond to you?
15. Implicit and explicit bias: Is the difference between implicit and
explicit bias clear to you based on this interview? What questions do
you have about each? Do you agree with Sue that looking at one’s own
biases is painful but necessary for multicultural competence? How
else might you address this issue?
THE INVISIBLE WHITE MAN
16. Equally victimized: What’s your response after considering Sue’s
assertion that whites are equally victimized in a racist society? Do you
agree or disagree? What are your thoughts about the ways that racism
impacts people of both marginalized and mainstream groups?
THE CATERPILLAR AND THE ANT
17. The model: What are your overall thoughts about multicultural
counseling? What aspects can you see yourself incorporating into
your work? Are there some components of this approach that
seem incompatible with how you do therapy? Which aspects of
multicultural counseling would seem most challenging to master? Do
you think this is an effective teaching model? Why or why not?
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Role Plays
After watching the video and reviewing “Sue’s Pioneering Approach
to Multicultural Counseling” in this manual, break participants into
groups of two and have them role-play a therapy session with a client
of a different cultural background from yours, using a cross-cultural
approach.
One person will start out as the therapist and the other person will
be the client, and then invite participants to switch roles. Clients may
play themselves, or role-play a client, friend, or another person you
can make up. Decide on a presenting problem as the client in order to
focus the session and create a context for cultural difference to arise.
The primary emphasis here is on giving the therapist an opportunity
to practice opening to clients’ and their own experiences regarding
cultural difference, and giving the client an opportunity to see what it
feels like to participate in this type of therapy.
The therapist should begin by finding out what has brought the client
to therapy. Invite the client to get very detailed and explicit about their
symptoms, and watch for statements or situations that indicate an
opening to discuss or inquire about your cultural differences. Support
the client in relating their experience to you.
Following what Sue discusses in the interview, you may want to
consider the three levels of experience with your client; your clients’
cultural values regarding the family and their place in it; your own
assumptions about the client’s experience; and what your client may
be wondering about your own experience. Continue to practice
therapeutic attending behaviors with your client, remembering your
role as a supporter of their growth and mental health while also
attending to your own internal responses.
After the role-plays, have the groups come together to discuss their
experiences. What did participants learn about Sue’s approach to
working in a cross-cultural way? Invite the clients to talk about what
it was like to role-play someone discussing cultural difference and
how they felt about the approach. How did they feel in relation to
the therapist? Did they understand the essence of Sue’s approach?
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What worked and didn’t work for them during the session? Did they
understand the therapists’ interventions? Would they be able to work
with a therapist in this way? Then, invite the therapists to talk about
their experiences: How did it feel to facilitate the session? Did they
have difficulty following the approach? Did they notice any strong
countertransference feelings arise? What would they do differently
if they did it again? Finally, open up a general discussion of what
participants learned about multicultural counseling based on Sue’s
approach.
An alternative is to do this role-play in front of the whole group with
one therapist and one client; the rest of the group can observe, acting
as the advising team to the therapist. At any point during the session
the therapist can pause to get feedback from the observation team, and
bring it back into the session with the client. Other observers might
jump in if the therapist gets stuck. Follow up with a discussion on
what participants learned about using Sue’s approach to multicultural
counseling.
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Reaction Paper for Classes and Training

Video: Multicultural Competence in Counseling and Psychother-
apy with Derald Wing Sue
• Assignment: Complete this reaction paper and return it by the
date noted by the facilitator.
• Suggestions for Viewers: Take notes on these questions while
viewing the video and complete the reaction paper afterwards.
Respond to each question below.
• Length and Style: 2-4 pages double-spaced. Be brief and concise.
Do NOT provide a full synopsis of the video. This is meant to be a
brief reaction paper that you write soon after watching the video—
we want your ideas and reactions.
What to Write: Respond to the following questions in your reaction
paper::
1. Key points: What important points did you learn about
multicultural counseling? About working with clients from diverse
groups? What stands out to you about the ideas Sue presents?
2. What I found most helpful: As a therapist (either white or
minority), what was most beneficial to you about the theories
presented? What tools or perspectives did you find helpful and
might you use in your own work? What challenged you to think
about something in a new way?
3. What does not make sense: What principles/techniques/
interventions did not make sense to you? Did anything push your
buttons or bring about a sense of resistance in you, or just not fit
with your own style of working?
4. How I would do it differently: What might you do differently
from Sue when approaching work with clients whose cultural
background differs from yours? Be specific about what different
approaches, interventions and techniques you would apply.
5. Other questions/reactions: What questions or reactions did you
have as you viewed the therapy sessions with each couple? Other
comments, thoughts or feelings?
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Related Websites, Videos and Further

Reading
WEB RESOURCES
Association for Multicultural Counseling and Development
www.multiculturalcounseling.org
Journal of Cross-Cultural Psychology
jcc.sagepub.com
International Association for Cross-Cultural Psychology
www.iaccp.org
Microaggressions in Everyday Life Blog on Psychology Today
www.psychologytoday.com/blog/microaggressions-in-everyday-life
The Microaggressions Project
www.microaggressions.com
RELATED VIDEOS AVAILABLE AT

WWW.PSYCHOTHERAPY.NET
Group Counseling with Children: A Multicultural Approach with Sam
Steen, PhD, and Sheri Bauman, PhD
Group Counseling with Adolescents: A Multicultural Approach with Sam
Steen, PhD, and Sheri Bauman, PhD
A House Divided: Structural Therapy with a Black Family with Harry
Aponte, PhD
Tres Madres: Structural Therapy with an Anglo/Hispanic Family with
Harry Aponte, PhD
Emotionally Focused Couples Therapy with Same-Sex Couples with Sue
Johnson, EdD
The Psychological Residuals of Slavery with Kenneth V. Hardy
Integrative Family Therapy with Kenneth V. Hardy
Psychotherapy with Gay, Lesbian, and Bisexual Clients: A 7-Video Series
The Legacy of Unresolved Loss: A Family Systems Approach with Monica
McGoldrick
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RECOMMENDED READINGS
Gerstein, L. H. et al. (2009). International Handbook of Cross-Cultural
Counseling: Cultural Assumptions and Practices Worldwide. Sage
Publications.
Rothenberg, P. S. (2011). White Privilege (4th Ed.). Worth Publishers.
Sue, D. W. & Sue, D. (2012). Counseling the Culturally Diverse: Theory and
Practice (6th Ed.). San Francisco: John Wiley & Sons.
Sue, D. W. (2010). Microaggressions in Everyday Life: Race, Gender, and
Sexual Orientation. San Francisco: John Wiley & Sons.
Sue, D. W. (2005). Multicultural Social Work Practice. San Francisco: John
Wiley & Sons.
Wise, T. (2011). White Like Me: Reflections on Race from a Privileged Son.
Soft Skull Press.
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Complete Transcript
WHAT IS MULTICULTURAL COUNSELING?
YALOM: Hello, I’m Victor Yalom. I’m pleased to be here today
with Dr. Derald Wing Sue. He’s widely acknowledged as the leading
authority in the field of multicultural counseling. He’s the co-
author, along with his brother David, of the influential and widely
read textbook Counseling the Culturally Diverse, as well many other
books—over 150 scholarly publications. Welcome, Dr. Sue.
SUE: Thank you.
YALOM: I want to talk to you today about a wide variety of topics,
but relating to your field of multicultural counseling. So, why don’t we
start more broadly. What does that mean, multicultural counseling?
SUE: Well, to me it means the ability to develop cultural competence
in working with different racial, ethnic minority groups. And when I
first started becoming interested in it, I noted that most of the theories
of counseling and psychotherapy were white Western European
in origin. They’re primarily the creation of Western European
men, which reflected a worldview that was quite different than the
worldview I was raised in, with my parents. And it was out of that,
that I began to really notice that counseling and psychotherapy
traditionally was quite inappropriate and oppressive towards clients
of color who came in for counseling and psychotherapy, because their
worldviews were quite different from that that most traditional forms
of therapy came from.
YALOM: What alerted you to that? I’m sure many things, but I think
many therapists would think that we work with lots of different kinds
of clients, and everyone has a unique story, and part of our core of our
basic training is to be curious, and empathic, and understanding, yet
obviously in your eyes, that wasn’t enough.
SUE: No, it wasn’t enough. And much of what I’ve come to understand
about counseling and psychotherapy came through my own graduate
training at the University of Oregon. I loved psychology. I went into
counseling and psychotherapy, and loved the work of Leona Tyler,
who was then really much into career, vocational, educational, and
15
personal counseling. One thing that I discovered was that much of

what they valued in terms of counseling healthy human development
was not what I was raised to be. For example, I discovered that almost
all of the professors I had emphasize individualism as the road to
mental health. In fact, I was taught the developmental theories of
Erikson, Jean Piaget—and almost all of them, I noted, equated healthy
maturity and development was with individuation from the group.
Now, my father and mother always emphasized that I was part of the
family. And that individuation, while it might be valuable in certain
conditions, that becoming an individual often times meant that you
would break away from the family and not have the collective identity
that was so valued. As I went through graduate school, I also began to
realize that what I read—Freudian psychology, existential, humanistic
psychology—did not resonate with what I consider to be effective
therapy with Asian Americans.
And then my first position was at the University of California-Berkeley
where I began to do therapy with a number of Asian American clients,
and with some of the African American clients—the students who
came in. And the types of conflicts that they went through was not
really addressed by traditional forms of counseling and psychotherapy,
and in some sense pathologized their cultural values.
YALOM: Such as?
SUE: For example, if an Asian American client came in and you were
to give them an interest inventory, and it showed that they would
be better off instead of in electrical engineering, to be in a field like
forestry—
YALOM: So in interest then to the story, this is in—you were doing
career counseling?
SUE: Well, I did a number of things—career counseling, vocational
counseling, and personal counseling. But this is representative of
an issue that goes back. That in some sense, I would say that your
strong vocational interest inventories indicate that perhaps you’re on
the wrong major, and maybe you should think about switching into
something that you’re finding more interest. And they would say to
me things like well, before I can change my major, I have to check with
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my mother and father. And the way that I was taught was that here
we have someone who is a junior in college, becoming—moving into
adulthood. They should be able to make decisions on their own. And
what I would be taught would be—traditional training—was that
they were dependent, immature, and they should make this decision
on their own. And I realized that if I impose those values upon them,
I was pathologizing a cultural value in which it was considered very
appropriate to first consult with your mother and father, or your
parents, before going on and making a decision.
YALOM: So that was kind of a microcosm of a real clash of
worldviews.
SUE: Yes, and it was reinforced when my brother Stan was at UCLA
doing research at the psychiatric institute there, in which he relayed
stories to me about psychiatrists who would approach him and ask
him, or make a comment, we know that you’re doing research on
Japanese American clients, did you know the Japanese are the most
repressed of the clients we’ve ever work with? And it was then that
Stan and I formed the Asian American Psychological Association
because we knew that among Asians, traditional Asians especially,
restraint of strong feelings was considered wisdom and maturity, and
free expression of feelings were indeed considered immature. And
that’s why one’s ability to control their feelings and emotions, among
Asians, oftentimes led to the concept of the inscrutable Asian, which
again was an indication of pathologizing a strong cultural value,
because counseling and psychotherapy wants our clients to freely
express their feelings. And this is considered a cultural taboo among
many Asians and Asian Americans who come in for help.
YALOM: Yeah, so it sounds like you were quickly confronted with the
cultural biases of what is normality, what is a positive mental health,
what is psychopathology, and how embedded that was in culture.
SUE: True, and with that under our belt—Stan and I had formed,
like I was saying, the Asian American Psychological Association—
he began to do a number of major studies in the utilization of
mental health services by individuals of color in the entire state of
Washington. And three of those groundbreaking studies indicated
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several important things that really jarred my concepts about

mental health, and began to introduce what I consider to be a social/
political element in counseling. And that was that people of color
tended to underutilized nearly all of these psychiatric services in the
state of Washington in proportion to their population. The second
outstanding finding was that once people of color did go in for
counseling and psychotherapy they terminated at a rate of over 50%
after the first initial contact. This is in marked contrast really to a less
than 30% premature termination rate among white clients who came
in.
Now this led me to begin to ask the question, why is it so? Why is it
that regardless of the group—and now I’m talking not only about
Asian Americans, the study encompassed Latino Hispanic Americans,
African Americans, and Native Americans, and white Americans—
and regardless of the four racial/ethnic groups, they all prematurely
terminated and underutilized. So the question we had was why. One of
the things we talk jokingly entertained was the fact that, well, people
of color are mentally healthier and don’t need that type of treatment,
and are cured quicker after only one session. We don’t really believe
that. We believe that in terms of all the studies that mental disorders
and personal problems are probably pretty equal across all racial/
ethnic groups, although they’re manifested quite differently. But when
we asked that question, we began to arrive at the answer that it was
the inappropriateness of the transactions that occurred between the
mental health professional and the culturally diverse clients who came
in for counseling.
Now this lead us to begin to talk about—what is there about
counseling and psychotherapy that may prove antagonistic to the
cultural values of all four of these groups of color. And we began to
look at what we call culture-bound values. For example, cultural-
bound values were things like individualism, in which psychology
believes that the psychosocial unit of operation is the individual, while
3/4s of the world, the psychosocial unit of operation is the family, the
group, or the collective society. And that creates problems.
The other thing that we noted was that most forms of counseling
and psychotherapy, even if it is cognitive behavioral in origin, values
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a certain amount of insight. That is that you’re considered mentally

healthier if you have insight into your own personal conflicts,
motivations, and behaviors. And again we realized that, for example,
my father always would, if I was anxious, his advice to me would
always be Derald, don’t think about it. Now, I was saying is he a quack?
That goes against what I was taught as a psychologist. You think about
it, you explore it, you get insight, you introspect.
Later what I learned in terms of studies done at Berkeley was that to
traditional Chinese, the road to mental health was the avoidance of
morbid thinking. And in fact, my father would oftentimes say to me
that you’re thinking—the reason why you’re anxious is that you’re
thinking too much about it. And we all know the work of Richard
Lazarus at Berkeley on stress coping, and it was in, I think, the
1980s where it became very well known for healthy denial as a road
to mental health, which was directly against the psycho-dynamic
concepts of insight. And I tell people that I’ve always resented Lazarus’
work because he received all the credit, and my father should have
been the one that got the credit for that.
These are culture-bound values, but there were class-bound values.
counseling and psychotherapy has traditionally been directed at
middle, upper-class individuals. The assumption being that you have
time to sit, and introspect, and talk about this. People coming from
poverty don’t enjoy—they come in, and what they want is, how can I
feed my family? Where can I get my next job? How do I get medical
help? These are immediate issues that clash with the 50 minute hour,
once a week, type of work.
And the third area we looked at was that linguistic factors oftentimes
worked against culturally diverse clients who would come in, because
the primary mode of counseling and psychotherapy is verbal behavior.
Standard English. And what we found was that the large gap between
translation oftentimes—even if the Latino client can speak English—
the translation was totally different in terms of affective types of
expression, and even interpretation.
COLOR-BLINDNESS
YALOM: What do you mean that the interpretation was different? Are
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these for native speakers, or non-native speakers?

SUE: Well, see, this is really interesting. People assume that if you have
been born and raised in the United States, and you’re Latino, that you
should be able to master English. Studies suggest that the acquisition
of English is even different if you have parents that speak the language
of Spanish, or Chinese. It affects how you put together English. And
what we’re finding is that if a person feels shy, feels anxiety, there
are different translations of that. And when the client can’t voice
it in English, what we find is that if you allow them to voice it in
Spanish, they tend to do better than if they’re locked into a primary
linguistic interpretation. But it’s these three things that really began
to make me realize that rather than heal and liberate, counseling
and psychotherapy can be very oppressive and make the person feel
worse. And those were the findings. That many of the individuals who
prematurely terminated would come out and make statements like
that, you know, we felt worse. We felt we were to blame.
YALOM: So you went and interviewed the people who just came in
once?
SUE: Not that population, but other populations that came out. We
began to talk to individuals that had gone through counseling and
therapy, and they came out saying certain things. One of the things is
that, I just don’t feel comfortable with Dr. Smith. He doesn’t seem to
be able, or she doesn’t seem to be able, to relate or understand what’s
going on with us. Or they may mean, I’m not sure I can trust Dr.
Smith because of certain things that are going on.
YALOM: So this is typically minority clients, white therapists?
SUE: Yes, yes.
YALOM: All right.
SUE: But the other thing that came out in our findings were
statements that therapists tended to be color-blind. That is that they
found it very difficult to talk about racial/ethnic cultural issues. Many
clients would say that they could feel uncomfortable anxiety from the
therapist when issues of race arose. And they would feel like, I’m not
sure—if the therapist is uncomfortable with talking about race, I’m
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not comfortable going to the therapist for help in any respect.

YALOM: So, did you have a sense, or did you get info on what gave
them the sense that the therapist wasn’t comfortable? Was it just body
language, tone of voice, avoidance?
SUE: Yes, OK. One of them was color-blindness. That is that the
therapist would emphasize things like—when a racial issue would
come up—the therapist would say something that, if I’m going for
therapy, Derald, I don’t see you as Asian American at all. You’re
unique, you’re just unique. Or that you’re very much like me, we’re
human beings. There’s only one race, the human race. I would feel
offended, like many clients of color, that an important aspect of my
racial cultural identity was being overlooked and ignored, and seen as
something that we should not talk about.
YALOM: So, I’m just wondering if you asked the therapist why they
might make an intervention like that, or a statement like that, they
might think that they’re trying to connect with the client and showed
that they don’t feel different, that they understand the client, but it
sounds like it might have a very different effect on the client.
SUE: That’s precisely—one of the things that oftentimes happens in
counseling and psychotherapy is that the therapist, in their attempt
to look unbiased, that they won’t discriminate, they tend to downplay
the group identities that people have by moving to the individual
identity or the universal one. And I know in terms of intentionality,
the intention is that I want to connect with similarities, or issues
that aren’t related to possible biases. The problem with that is that
it communicates an invalidation of a client’s racial, cultural, ethnic
identity. The second thing is that it communicates that the person is
reluctant or anxious to touch the racial issue that might be important
to deal with therapeutically. And the third thing, that oftentimes
is communicated with what I call a color-blind approach, or the
emphasis on sameness or individuality here, is that differences are
deviant. Whether the therapist is aware of it or not, the emphasis on
sameness is almost an escape, or a belief that being the same is good,
but being different is divisive and causes differences.
In multicultural counseling and therapy, what we try to do is to teach
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individuals that we have all three levels of identity. We have a universal

level of identity that is like what Shakespeare’s character Shylock says
that, “when I cut myself, do not I bleed?” That statement that we do
share universal identity.
SUE: The second level that I was talking about is one of individuality,
that we are all different in one way or another from individuals. The
third level that I find therapists—and many individuals, not just
therapists—find very difficult to touch is a group level of identity,
which includes race, gender, sexual orientation. Any time those
identities or issues are brought up, therapists and other individuals
tend to move to the individual level of identity or the universal level
of identity. And there you have a missed connection. And this is what
many of the clients that I’ve talked about, racial/ethnic minority
clients that I talk to, say that they don’t feel the individual, the
therapist, is able and ready to connect with them. They just feel kind
of this barrier that is between them.
YALOM: The therapist is not able to acknowledge the group aspect of
it, and I would imagine again it’s something that therapists don’t want
to be perceived as racist, or—
SUE: Or that they are. See, that’s a powerful statement. In our work,
and this is research that we’ve done with groups of color with white
individuals. In fact, what we find is that there are four different levels
of unravelling about why therapists may find it difficult to directly
address or talk honestly about racial issues in counseling and therapy.
The first level that we’re dealing with on a very superficial, is the fear
by the therapist that whatever they say or do will appear racist, even
if they aren’t. The fear is there. Now, that constricts their ability to
verbally interact with the client, because they either to dilute the
conversation, move to a different level, or show constriction. Some
therapists who have done research on it call it rhetorical incoherence.
That is a therapist is incoherent when it comes to talking about these
racial/ethnic issues. The second level is the most feared level. And that
is the level of realizing that you do have these biases and prejudices,
although they are outside the level of your conscious awareness. And
it is difficult for therapists to realize that because it conflicts with their
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image as good, moral, decent human beings.

YALOM: That’s probably difficult for anyone to realize that, yes?
SUE: Yes, in fact this is something why much of my research doesn’t
deal primarily with therapists anymore, it deals with teachers, it
deals with employers, coworkers. It is representative of what I think
therapists however are going through. But that shatters their image of
themselves as being good, moral, decent individuals. And they are. It’s
just that they’re out of contact with the implicit biases that come out
unsuspectingly, and in inconvenient times, that the person of color,
the client of color, picks up very easily.
MICROAGGRESSIONS
YALOM: Is this what you refer to as microaggressions?
SUE: Part of it, yes. Microaggressions. Microaggressions are the
everyday indignities, insults, invalidations, and put-downs that well-
intentioned individuals deliver to marginalized groups—like people
of color, women, LGBTQ individuals—unknowingly. It is outside
the level of their conscious awareness. The microaggressions on the
surface appear to be innocent inquiries, complements. But indeed they
contain a meta-communication, a hidden message, that invalidates,
insults an individual. And these microaggressions, that can be
delivered by anyone, especially damaging in therapy, by the therapist,
can be verbal, nonverbal, or even environmental. How their offices is
set up is oftentimes invalidating.
YALOM: How could that be?
SUE: Well, let me give you an example. If you’re a therapist, and you
have pictures of all of the major founders of therapy—Sigmund Freud,
B. F. Skinner, Carl Rogers. If you have those on your wall, a person
who comes in, a client of color who comes in, will see those pictures
and associate them as primarily white Western European. Will this
person understand who I am in terms of the race and culture that I
come from? Or if you have a female client and they see pictures of just
all male therapists on the wall, they’re going to begin to think about, is
there sexism that is operative in here?
Now they may not even be able to verbalize it. They would just feel
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uncomfortable, that perhaps there’s a disconnect that is going on here.

But that’s an environmental—how you decorate your office oftentimes
communicates either receptivity or invitation according to cultural
themes, as opposed to other groups that might read it, so that this is
where the therapist is unintentionally delivering microaggressions,
and each time those microaggressions are delivered the credibility of
the therapist diminishes.
YALOM: Now, I’m wondering why you use the term microaggressions.
I mean, I could imagine a therapist thinking these are the people
they studied—or I don’t know a lot of therapists do have pictures of
all these on their wall—but, to go with your example, I can certainly
understand that it may not make a client of color feel comfortable,
and that’s something certainly to consider. But why do you call it a
microaggression?
SUE: Well, microaggressions is a term coined by Chester Pierce, and
African-American psychiatrist who did studies of TV programs,
advertisements, that portray people of color and women in what he
considered to be demeaning issues, or the portrayals that were going
on. And his studies indicated that these portrayals had negative
impact on the self-esteem and integrity of people who were receptive
to it. Now, advertisers didn’t know. They thought they were doing
something quite well.
It is also a term used by Maya Angelo. She refers to microaggressions
as the daily insults, the many cuts that are delivered to individuals.
Any one alone may not be that drastic, but taken cumulatively
they have major harm. And she oftentimes equates this to the little
executions versus the grand execution of an overt racist that is going
on. And the term is micro, but the impact is macro. Macro in terms of
the—it has major pain that people experience.
YALOM: All right, well I know you’ve written a whole book on that,
and that’s been in a big area of your work. And we could spend a lot of
time on that. But let’s get back to the therapist. You had listed points
one and two, and so let’s continue with that.
SUE: A third point that makes, I think, therapists really quite anxious
about talking about racial, gender, or sexual orientation issues is
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social/political. Which many of my colleagues really don’t want. What

I’m talking about is power and privilege. We’re dealing with the fact
that many well intentioned therapists do not realize that people of
color, in relationship to white individuals in this society, come from
a disadvantaged position—because of a concept that is gaining wide
usage, white privilege.
White privilege are the unearned benefits and advantages that
accrue to groups on the basis of their white skin. And so, when the
therapist responds to an individual that—let’s say a black client—
that, I think if you work hard enough, that you can achieve this goal.
Because everyone has an equal opportunity in this society. It is a
microaggressions and that is called the myth of meritocracy. And I’d
like to give the example of what this means that deals with the racial
realities of white therapists and clients of color. The example that I
like to give that embeds this issue of white privilege and power is a
statement that columnist Molly Ivans in the Austin Times, she passed
away years ago, wrote about George Bush. And she wrote and made
this statement—George Bush was born on third base and believes he
hit a triple.
This is where many CEOs, many people who achieved in society who
are white, tend to have the feeling that they worked hard, sacrificed,
and achieved what they did. And in reality, they did. They worked
hard. But what they don’t realize is that women and many people of
color have worked equally hard, but don’t even make it to the batter’s
box. That George Bush profited from male privilege, economic
privilege, and white privilege. They’re unearned advantages, and that’s
the way our society operates. And clients of color, when they come in
talking about these issues, generally feel put-off if the therapist cannot
understand what a privilege and power is all about. And that many of
the statements or assumptions that they operate from, operate from
privilege and power that disempowers clients of color. And this is what
happens in terms of the relationship that occurs.
YALOM: All right, and then the fourth?
SUE: The fourth one is that, if you are a therapist, and you realize that
you have power and privilege. You realize that you are biased, that this
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is made clearly, that you understand. It goes to another saying that

someone once said, in that the ultimate white privilege is the ability to
acknowledge your privilege and do nothing about it.
And I’m not inditing all therapists, but I’m saying that as a person of
color, I’ve got to do something about it. I face this every day. But that
many of my well-intentioned white brothers and sisters simply will
acknowledge that they have advantages, that racism exists, but they
don’t do anything about it. And I realize why it is that they don’t do
anything about it, because for them, to do something about it means
that they will alter their relationships with other individuals. When
they have family members telling racist, sexist jokes—it disturbs
them, but for them to try to bring it up and correct it, will isolate them
from the family. It means a really major change in your life, and that’s
very difficult for many well-intentioned individuals to do.
DEVELOPING CULTURAL COMPETENCE
YALOM: All right, so you’ve certainly laid a strong case for the fact
that traditional mental health treatment wasn’t working when you first
started for minorities. And that many therapists, white therapists, are
uncomfortable in terms of dealing with race for a number of different
reasons and on different levels. So, you’ve been obviously involved
in training therapists, and advocating multicultural competence, as
you call it, for therapists. So, what does that mean and how do you
inculcate that in students and therapists?
SUE: When I do multicultural training, there are four major goals
that I believe leads to cultural competence.
YALOM: OK, first of all, what does that mean, cultural competence?
SUE: Cultural competence is the awareness, knowledge, and skills that
allow you to work individually and systemically in an effective way
that is culturally congruent with the populations that you’re serving.
YALOM: Sure, that’s something I think we would all strive to.
SUE: Yes, but how it’s interpreted is quite different.
YALOM: OK.
SUE: It’s like saying that we all stand for equal access and
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opportunities.
YALOM: Sure.
SUE: Everyone would agree to that.
YALOM: Absolutely.
SUE: However, if I say that a part of equal access and opportunities is
affirmative action—oh, a lot of people who agree to the first—when
you operationalize it in specificity, you get objections of that going on.
But, that to me is a broad definition of cultural competence which if
you operationalize it, has four components. The first component is
awareness of your own worldview—the values, biases, prejudices, and
assumptions that you hold. And the worldview of the theories that you
are working from. Because those are the theories, and your worldview,
that is allowing you to determine normality, abnormality, healthy,
unhealthy functioning. I find that very
Difficult. And part of the understanding of worldview is not just your
cultural understanding. It goes back to what I said before—what does
it mean for you as a white therapist to be white. And I find people
find it very difficult. If you ask me, what does it mean to be Asian
American? I think I could tell you very quickly. If I asked a black
American—
YALOM: Well, let me ask you, what does it mean to you?
SUE: It means collectivism, family values that are very close to one
another, it means a group consensus that occurs. But I think the point
I’m trying to make here is that as a person of color, I wake up in the
morning, and I look in the mirror, and I know I’m Asian American. If
I ask you, when you wake up in the morning, and look in the mirror,
do you say, jeez, I’m white.
YALOM: No, I don’t.
SUE: Yep. That’s because whiteness is the default standard, is invisible,
and that invisibility inundates our theories of counseling and
psychotherapy, and what we define as mental health practice. And that
is what is being imposed on our clients. Even the definitions of affect
and feelings are different. When you as a white person—well, maybe
I don’t want to generalize—but when many whites do something
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wrong, they tend to feel guilty.

That’s not true for Asian Americans. If they do something wrong,
they may feel guilt, but the primary affect is shame. Because shame
reflects upon the entire family and group, while guilt is much more of
an individual affect. And as a therapist, when you don’t recognize it,
again there is this disconnect that goes on.
YALOM: OK, so let’s delve a little further into the first point. We
should have as thorough, as deep an understanding of our own world
view, and the assumptions that we’re living by, and the assumptions
that we’re imposing on others. How do you help develop that among
therapists? Because it seems like a laudable goal, for sure. OK?
SUE: Yes. And it’s a very difficult thing to do. But what you actually do
is have to deconstruct the theories of counseling and psychotherapy as
to how they are racially/culturally biased.
YALOM: So what does that mean? What does that mean to
deconstruct the theories?
SUE: Well, for example, I gave the example about almost all theories
of counseling and psychotherapy talk about individualism. They talk
about autonomy, independence, being your own person, and that is
equated with healthiness.
YALOM: Although, some of the new—there’s a lot of focus on the
attachment these days, which is countering, I think, some of the
extreme individualism.
SUE: Yes, and those are changes that really are occurring as a result
of, I think, our changing perceptions of different group embededness
and values that are going on. How people form relationships. But
that would be, I think, one of the things of deconstruction. Insight. A
cause-effect, or linear orientation, that is so typical of a cognitive and
behavioral—when I was debating Albert Ellis, one of the major things
that I pointed out to him was that his concept of what is rational
is culture-bound. That in Asian, in African American, and Latino
cultures, rationality looks quite different from what he talked about in
REBT therapy. That’s what early training needs to look at closely. And
then the importance is getting people to begin to explore their own
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values of why they consider certain behaviors abnormal, and what our
normal. It’s very difficult for people, and I usually work from the four
basic taboos that they operate from. Therapists do not self-disclose
their thoughts and feelings. That’s a taboo that is linked in the ACA
and APA standards and guidelines of practice.
YALOM: Well certainly there’s—that came from historically from
psychoanalytic work, but certainly different schools take different
takes on that. But I think there certainly is a bias that we keep, and we
keep guard in that way.
SUE: Therapists do not serve dual role relationships. Therapists do
not accept gifts from their clients, because it might unduly influence.
These therapeutic taboos are precise qualities that many Latinos
and African Americans consider to be therapeutic means of forming
relationships that are going on.
And the rigid application of these, and the belief by students going
through this, has to be deconstructed—unraveled. So they can
look at it and say, yeah, self-disclosure can be done, but it has to be
done sensitively and for a particular goal and reason. But the all-
encompassing, rigid taboos that sometimes I encounter in clinicians, I
feel, is really quite damaging to individuals.
THE RACE LAB
YALOM: Well, I think that’s true—certainly true from the lens
you’re looking through that we’re talking about from a multicultural
perspective. And I think it’s just true from a therapeutic perspective,
that anything that’s applied rigidly without taking a multitude
of factors into account is going to be anti-therapeutic rather than
therapeutic. OK, so those are some things. What are some other
things? What are some other ways that you help develop that are
critical to developing multicultural competency?
SUE: We put them through what we call the race lab. That involves
a great deal of role playing, a great deal of keeping journals, to talk
about issues that they’re going through. And it is oftentimes very
unpleasant and uncomfortable when the values and assumptions
that are made by our students, we confront them with that. But that’s
a need. I mean, what I’ve learned in all of my practice—cultural
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competence isn’t simply reading a book. Acquisition of knowledge—it

has to encompass experiential reality. And that was one of the major
limitations of therapists. They may mean well. They may want to work
with clients of color, or other socially marginalized individuals, but
they lack experiential reality.
They read about the groups, but they have little to do with the group.
They don’t socialize with them. They don’t go to the communities, the
public events. They have very little—and there is this big discrepancy
between cognitive knowledge and understanding, and affective
changes and behavioral changes that occur in individuals.
So part of the thing is that we send them out to communities where
they interact with people that they’ve never—we send them to African
American churches, and boy, they are so uncomfortable when they go
there. And they have to engage in response call with the preacher and
the audience. But that is something that is very important for them to
begin to experience, because they have never experienced, nor have
they engaged in behaviors that allow them to interact in a smooth way
with people who differ from them significantly.
YALOM: But just hearing about that, it makes me a little
uncomfortable to be thrown into a situation where you’re a minority,
and you’re a stranger, and so it seems to me—
SUE: See, that’s another issue that I want to say, and that is that I am
always with people who are different.
YALOM: Right. I was thinking that.
SUE: As a white person, you probably have very few times in which
you are in an all black group, an all Asian group, or all Latino or
Native American group. But as a person of color, I have no choice
in that. If I want to make it in this world, I have to interact with
people who differ from me. And that’s part of white privilege. White
privilege is your ability to decide whether you want or don’t want to
have interactions with certain groups. And that is what prevents us
from really developing cultural competence that has meaning on an
emotive and behavioral level. Having it just on the cognitive level will
not make you an effective multicultural therapist.
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YALOM: I could see there would be a lot of resistance to people going.

Who wants to put themselves in an uncomfortable situation? I hear
you’re saying that that’s not a choice for you, but—
SUE: But we help them too. Victor, we just don’t say OK, go out on
your own. We have usually a liaison, or someone in the church who is
willing to. One of the worst things that you can do is to send someone
alone, without the appropriate support, into a situation. And then they
can come back and process their thoughts and feelings and fears that
are going on, and for us to begin to talk about it.
YALOM: That sounds a little better.
SUE: No, we don’t drop them.
YALOM: OK. But it seems to me the value is A, having that contact, I
mean on two levels that at least strikes me. Having that contact so you
get to know a different cultural group in a different way. And that may
be more cognitive and experiential. And then B, having that personal
experience that you’re saying, you have every day of your life. So, what
else do you do? What else do you do?
SUE: I tell my—you know, we do—that’s enough. Because it brings
out so much feelings and processing that goes on, plus the fact of role
playing—working with clients of color, with women, with LGBT. We
have certain scripted issues that we want to present that may have
racial topics.
For example, we may have a black student volunteer role play a black
client with a white counselor therapist trainee. And the issue might
be the issue of trust/ mistrust. And one of the common things that
happens in multicultural therapy is that clients of color will come in,
especially if they have a racial concern, with the thought of—what
makes you any different from all the other well-intentioned white
neighbors, white teachers who said they wanted to help me, but indeed
operated from unconscious biases? What makes you the therapist any
different from all the others out there.
The second challenge that they are likely to do, to give to you, is to
challenge your credibility as to how open and honest are you about
your own biases. And they may make statements as their talking
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to you—their presenting a racial issue, was that, can you possibly

understand the black experience? And watch your reactions to that.
Or even ask you. These are challenges that occur.
YALOM: And these are things you role play?
SUE: Yes, yes. But they do come up in setting. That’s why we scripted
them from therapeutic—actually, one of them might be if a black
client is involved in an interracial relationship, they may come in and
in some way ask you, how do you feel about interracial relationships?
And we will watch the nonverbal and the verbal behaviors. And
oftentimes we’ll find trainees saying that, well, I think it’s fine. And
what is happening here is that the verbal statement is contradicted by
the non verbal. And we’re videotaping all of these role plays, because
we come back and look at it, now later, to explore the meaning of it.
We also give knowledge and understanding to the trainees that study
after study suggests that people of color and women are better readers
of nonverbal cues than their white male counterparts. I mean, there’s a
lot of reasons for why that is true. It’s because there’s a common belief
among people of color that—don’t listen to what Dr. Smith says, but
how he says it. Behind that statement is a belief that the nonverbals
are more accurate predictors of where that person is coming from. So
when you respond by saying, oh, interracial relationships are fine with
me, you are sending off also nonverbal cues that may only reinforce
the thought of a client of color, that isn’t this typical of white folks—
say one thing, mean another.
Now, these are really uncomfortable role plays that occur within
individuals, because how you meet the challenge will either—and
we tell them—with either enhance or negate your credibility with
the client that is coming before you. But more importantly, it forces
you in our processing, as we watch the videotape tape, to go on your
own assumptions, values, and potential biases. And it becomes very
uncomfortable for individuals to go through that type of training.
YALOM: All right, it’s uncomfortable—so is this in the context of a
one semester course, a yearlong course?
SUE: One semester. But our program at Teacher’s College at Columbia
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University is consistent. It consists of—for a master’s level students,

they go through two years. Almost all our courses are infused with
multiculturalism. When you take a course on family dynamics, or
family process, we talked about the Asian American family, the black
family. I mean those are sort of part and parcel, so it’s not simply the
three courses that require multicultural counseling. They are part of
assessment, part of group therapy, and that’s what we do in terms of
infusing it into the education.
YALOM: Let’s get back to the race lab that you do. That’s what you
call the class? All right, so I’ve certainly heard—I’ve talked to lots
of colleagues and students, and I’ve certainly heard a wide variety
of experiences that people have had in whatever the class is called at
that particular school. And I’ve certainly—I’ve heard some people
have positive experiences, and as you say its uncomfortable, so I’ve
certainly heard that there’s uncomfortable—But I’ve also heard,
a number of, frankly horror stories, where the class is just—self-
destructs . Bad stuff happens. I heard a case where an LBGT student
received a death threat. I mean, that wounds were opened up that
never repaired throughout the course of a four or five year Ph.D.
program, so—
SUE: Yeah, I think that those reports came from early courses in
terms of the race lab, and I do agree that there were major issues
depending upon the instructor. Who taught it really becomes, when
you teach—
YALOM: And some of these are current—recent.
SUE: Well, then I don’t know. What you need to do is balance the
challenges with the supports that students get. But apart from
that, I think when you deal with your own biases, it’s not only
uncomfortable, it can be quite painful. And in today’s conversation
that I, conversation hour, there were a number of people who up
and talked about—faculty of color—who came up and talked about
the fact that they have difficulties teaching a diversity, multicultural
course based upon the reactions that students would have and the
unsupportive reactions that administrators did.
In fact, I think what I tried to confer with them is that when you push
33
buttons in people, you do open up wounds that they have. It’s not
pretty or exciting, oftentimes, to look at your biases. But the other
end of it is that I have some thoughts about the fact that when you
deal with implicit bias, it is painful. And all of our—the studies that
I shared with the group today, indicates that multicultural training is
very good at enhancing multicultural competence and diminishing
explicit bias, bias that we’re aware of and know of. Multicultural
training seems to have minimal impact on implicit bias. And the issue
now becomes—what type of training taps implicit bias? This is among
the first studies that came out in the past few years about the success
of multicultural training—
YALOM: So just quickly, I don’t want to get too much into detail, but
how is that assessed? How do you test whether it’s effective?
SUE: Well, they use what we call the implicit attitude test. This
is—you probably heard about it—it’s on the Harvard website. And
what they do is they measure the quickness of response of measuring
positive words with faces of blacks, Asian, women, white individuals.
It is very much patterned after the work by Joseph Correll who talked
about the quickness by which police officers in simulated games fire at
what they consider to be a white suspect or a black suspect.
YALOM: So it’s a test that’s gathering instant reactions that can’t be
consciously manipulated?
SUE: Yes. And so, that’s different from taking—you know, do you
believe blacks are unintelligent, prone to crime. You’ll say no and no.
And, the people who take the IAT truly believe that they are unbiased,
but when they take this test about 85% come out revealing that they
have these implicit biases. Don’t ask me about the other 15%.
And they’ve also developed an IAT for children, going as low as five,
six, 10, 11. And they measure both implicit/explicit bias, and find
that as you get from three to four, to 10 and 11, both implicit and
explicit bias increases. From about 10, 11 to adulthood, explicit bias
among white individuals plummets consistently. Implicit bias does not
change.
YALOM: So you’re saying implicit bias is not affected by these courses.
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SUE: Yes. And all the time, I’ve been operating under the fact that we
have been doing, and tapping it, with what we have. And now I think
the great challenge is how do we address the implicit biases that people
have. And, I honestly think that it may not be possible to do. And that
the remediation that we currently have set up in training may not tap
that.
So what it means to me is prevention. And if we take a preventive
approach, then I look at the pre-K through 12 group. That, if you
truly had a multicultural, anti-racism, anti sexism curriculum from
pre-K through 12, the people who go through the program won’t
have accumulated the biases that you and I have now. And this is
something, by the way, I want to make clear—that people of color
also have prejudices and biases because we’ve all been the product of
the social conditioning. So that when you talk about multicultural
counseling and therapy, you’re not just talking about black/white,
Asian/white, Latino/white. You’re talking about Asian/black,
black/Latino, Latino/white, white/Native American, all of these
combinations.
YALOM: you wrote in the forward to your book, I believe, that when
you first—the first edition came out in the 1980s, something like that?
SUE: 1980.
YALOM: Yeah.
SUE: A long time ago.
YALOM: You got a lot of hostile reaction, including that you were a
white basher.
SUE: Yes, well actually, it was stronger. I was a racist, but of a different
color. People would call and write about this. But I guess you go
through a period of evolution where I no longer see white individuals
as primarily oppressors. I see them as equally victimized in a racist
society. That my victimization is different from yours, but we’ve been
all culturally conditioned to have certain biases and images about
one another, and I realize now that none of us came into this world
wanting to be a bigot. I didn’t, at birth, wanted to be a racist, or—we
took this on through a flawed system of social conditioning that
35
occurs through the mass media, through education, significant others

and institutions.
YALOM: And it seems to occur universally. I mean, wars are not a
new thing.
THE INVISIBLE WHITE MAN
YALOM: It’s hard to argue with statistics that are widely available
and you’ve quoted many places, that white males do hold a position
of privilege in this society and hold positions of power. But in your
textbook, you have chapters on counseling Latinos, counseling
African American, counseling Muslims, counseling LGBT, counseling
and women. You don’t have a counselor on counseling men, or
counseling white men.
SUE: Well, is an interesting statement that you’re making, because
isn’t that what psychology is? Robert Guthrie, an African American
psychologist, wrote a book that took off. That was called Even the Rat
was White. What he was saying is that history of psychology, all the
values, come from a white Western European perspective. And it was
his statement that this, to me, is the invisibility of whiteness.
I remember when I and my colleague at the California State University
at Hayward advocated for a course on multicultural counseling or
counseling of Asian Americans and blacks—my white colleagues,
well-intentioned, would say that, well then we should have a course on
counseling whites. And my answer to them, a response was that we do
already. All of psychology is based upon that.
YALOM: No.
SUE: You don’t agree with me.
YALOM: Well, your point’s well taken, but no. Well, I guess the only
thing I’d counter is that I think a lot of the history of psych care, and
psychotherapy, was male therapists or analysts, female clients, and
there are people like Ron Levant who has written a lot about a lot of
men feel shamed in therapy. That we’re socialized, I think as men—
white men, and I’m sure Asian men in a different way—that getting in
touch with our feelings is not the thing to do. Studies have shown at
the age of nine or 10—up to the age of nine or 10—I think boys and
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Psychotherapy.net
girls cry equally, and then boys learn quickly that that’s not the thing
to do. And I think there are specific things that, for men that don’t
easily access their feelings.
SUE: I agree, and Ron Levant’s work is very good. It might make
you feel better that in our most recent book on case studies and
multicultural counseling and therapy, we include white men in terms
of the special issues that they encounter. And that is important. I’m
not saying it’s not important, but I’m saying that overall psychology
is very white. And the invisibility of whiteness—see, I oftentimes
say the goal of counseling and therapy, the goal of our society and
actually beyond that, is to make the invisible visible. And whiteness
is an invisible default standard that really comes out in all aspects
detrimentally.
For example, in the George Zimmerman verdict. What was
happening, if you recall during that verdict, the Judge said to everyone
that you cannot use the word racial profi ling. You can use the word
profi ling, but not racial. Both the defense and the prosecution said
that race was not an issue. After the verdict of not guilty, when Juror
B37, a white woman came out, she said during the jury deliberations
race never entered the dialogue or discussion.
Now, what I would say is race always matters. By eliminating African
American life experiences, by saying that’s no longer—the default
standard was white. And whiteness entered into the determination
of what could or could not be the outcome. It’s primarily like when a
Latino student is told by a white teacher, that I don’t care if you come
in and talk about these holidays and art, but I want you to leave your
cultural baggage outside of the classroom.
Well, if I was to say to the teacher, I don’t care that you’re the teacher
in the class here, but I want you to leave your white cultural baggage
outside, the person wouldn’t know how to teach. It wouldn’t make
sense to them. Because teaching—the curriculum, how you ask
questions, how you lecture, are Western European methods of
education that differs considerably from other groups. Among African
Americans, you don’t sit passively. You enter a response call. If you go
to the African American churches, if the preacher gets up and makes a
37
statement, the congregation says right on, say it again.

Supposing you are white teacher and you have a black student in
your classroom, and you’re talking about President Obama, and the
student says right on teacher. What would the teacher do? Johnny,
you sit down and be quiet. I mean, this is the imposition that occurs.
And this is where the invisibility happens in terms of counseling and
psychotherapy standards of normality, abnormality. Culture is there,
but it’s white Western European culture.
THE CATERPILLAR AND THE ANT
YALOM: Yeah. So let’s take a look at what you would advocate in the
therapy or counseling room, assuming someone has achieved some
level of cultural competence—and I’m sure it’s a gradation, you don’t
either have it or don’t. A typical example, you’re a white therapist and
you have a minority client, African American, Asian American, et
cetera. What do you do?
Because I’ve heard many years ago advice that you should always bring
it up. You should always say at some point early on in therapy, first
session, how does it feel for you to be in the room with me, a white
counselor. And I’ve heard therapists say that doesn’t always go so
well. And then there are folks like Kenneth Hardy, African American
psychologist, who says that, that can really put the client on the spot.
And instead he advocates maybe having a more invitation, by talking
about his own experience, and signaling to the client indirectly, this
is something I’m comfortable to talk about. What are your thoughts
about that?
SUE: First of all, we are making an assumption that the trainee is
aware of themselves as a racial/cultural being. Because no matter what
advice I give, or suggestions, if the person isn’t aware of their racial/
cultural being, they are not going to be—it’s not simply a technique
oriented situation.
YALOM: OK, that’s good to hear.
SUE: Yeah, and the other thing that is really quite important is that
whether you bring the issue of race up or not, and when you do it,
depends on two situations. One, are you aware that race may be an
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Psychotherapy.net
issue. Two, are you comfortable in talking about race. Because if you’re
aware but not comfortable, it’s not going to go well. My feeling is that
because race is always an issue, it’s a clinical decision about when
you—whether you bring it up initially, or wait for when, as Ken Hardy
says, that it’s more appropriate that the client invite you. To no bring
race up if indeed it is something that the client is not focusing in upon,
because it’s far outside of what—it may seem totally inappropriate.
But when you sense that the person is involved in thinking about—
can Dr. Yalom really understand what I’m going through? When
you begin to experience that, it may be a possible—and probably
recommended—that you bring up the issue of race. And that might be
acknowledging that you’re trying to understand his experience from
a white perspective. That you’re comfortable about talking about that
issue. But when you do it, it is really a clinical decision in terms of the
timing and appropriateness of it.
YALOM: All right. So, it’s good to hear that it’s not something
automatic, or a technique. Because I think, whether it’s a racial issue
or some empirically validated treatment of some other kind, you
always want to exercise a clinical judgment.
SUE: And the second thing I think I would say is that the culturally
competent therapist is a therapist who is able to engage in a number
of different helping behaviors, and comfortable with doing that
what. What is that—the skills training. You have the Ivy—Alan Ivy’s
microtraining dynamic divides up helping skills into attending and
influencing skills. Attending skills are what you think about Carl
Rogers and person-centered counseling. It’s uh huh, please go on.
Head nods, appropriate eye contact. But the attending skills are not
taught to our trainees very well.
Now, attending skills are skills like giving advice and suggestions.
Self-disclosing. Expression of content, expression of feelings. These
are generally considered to be taboo types of behaviors that beginning
trainees avoid. And what we try to do is expand their repertoire,
because they are very good at paraphrasing, reflecting feelings, but
they are not good at expressing content, summarizing, doing other
types of behaviors. And if you operate predominantly on the attending
39
skills, of how you relate to a client, many African American clients

would feel that that’s unhelpful to me. I want advice and suggestions. I
want to know where you’re coming from. I want to know your feelings.
Because that’s a measure to them of authenticity. That you’re willing
to engage in the relationship, to establish this working relationship.
And what we find, is that—I give this example to students about
the caterpiller and the ant. Because the caterpillar is going up a leaf,
climbing up the leaf. All the legs are working in unison. And the ant in
admiration, and astounded, walks up to the caterpillar and says how
do you do that without tripping? Well the caterpillar thought about it
and tripped.
That’s what is happening with many of our trainees, that they actually
become less competent and capable therapists as they go through
the training because they become so self-aware of what they’re doing
that the new behaviors aren’t natural and authentic to them. And so
that’s what we work on, for them to become much more natural and
authentic.
YALOM: Well I think that may be the case with many skills you learn.
Whether it’s playing piano, or tennis. If you’re that early stage, you
become self-conscious, and as you move towards mastery, you drop
those voices in your head telling you what to do.
SUE: And there are times when you can’t be everything to everyone.
Where you don’t have those skills. And the next best thing that we tell
our students is for you to be able to anticipate your social impact on
the client. We know that clients have different beliefs about how to
deal with the things, and if the counselor or therapist is unable to do
it, this rupture in their relationship may happen. But a therapist who
is aware that that is going to have a negative impact upon the client
can take steps to soften the blow. That may—
YALOM: For example?
SUE: Well, OK. A long time ago I worked with counseling with Asian
Americans, and one of my—at the clinic, at Cal State Hayward—we
had a Filipino client come in to work with a white female therapist
trainee. And we have things like observation rooms where we observe
40
Psychotherapy.net
what’s going on. He came in to the session, it was not a student, he

was in the public coming in for—and he came in with a issue that
he presented, kept about the relationship with his recent marriage
with his wife. But he presented the issue in a roundabout way and the
therapist was limited.
My father was really good at subtlety, at talking about something as if
he’s not talking about it. And the Filipino client really was expecting
the therapist to not talk about it directly, but to indirectly touch upon
those topics. But she didn’t have that subtle—
YALOM: That’s a difficult—yeah, that’s a difficult skill.
SUE: And so, as the session went on, it became clear to us—the
group that was observing—that the Filipino client had an issue with
sexual relationships. He didn’t want to say it. It was too shameful and
embarrassing. And as the session went on, the anxiety increased, and
we all knew that this client was not going to come back. Until the
female therapist took a risk. She said to him, I know this will sound
very Western to you, and I don’t mean to be that direct, but I really
don’t know how to address this issue. I apologize, please forgive me,
but are you having sexual difficulties with your wife?
And the Filipino male sat bolt up, upright. But rather than ending the
session, he continued to work with her. And our analysis was that—
the truth of the matter was that he found out on his wedding night
that his recent wife was not a virgin. Now, many of us would say, big
deal now about it. But for him, the cultural dictate was that his family
was betrayed by him not knowing. And the legitimate thing to do was
to divorce or have the marriage annulled. And he didn’t want to do,
that because he loved his wife. And so this was what he wanted to talk
about.
But what we found out was that the therapist anticipated her social
impact. Indicated that this was a weakness of her own, not anything
due to him, and said I really want to work with you, I apologize if
this is going—That to me was an indication, not only that you have
to have the skills, but if you don’t and you’re up against—being able
to anticipate your social impact, and I find that most trainees have
very little idea about the social impact they have on people. And
41
videotaping is really powerful to give them insights into how they

come across to others.
YALOM: All right. So, we’ve been talking a lot about training. Just
before we wind up, if you—if someone gets some level of real mastery
of multicultural competence, what does that look like. What is master
multicultural therapist look like?
SUE: I think that the four things that I’ve said. Self-awareness of
yourself as a racial/cultural being. Awareness and understanding
of the groups that you hope to work with, and understand that you
understand their worldview. Not that it’s particularly that you buy
into it, but you understand it. The ability to engage in a wide range
of culturally appropriate intervention strategies that involve not
only culture specific, but cultural universal helping strategies. And
the fourth thing that we haven’t talked about, really, is the systemic
understanding about how systems affect the client, and how your role
as a helping professional, since you are employed by an organization
or institution, or working in private practice, how you are influenced
by that. Those are things that I look for.
And then the other thing I would say is that multicultural or cultural
competence is not an end state. It is a constant, continual journey that
people are making. I’m still learning things from my LGBTQ brothers
and sisters that I really—that amazes me sometimes in terms of going
up and talking, they indicate to me that I have a distorted view of what
might be going on. And I always like to say that we will all commit
blunders. We will all commit racial, gender, sexual orientation
blunders. The importance is how you recover, not how you cover up.
And I find beginning therapists, and even established therapists, when
they commit a blunder, get defensive and cover up rather than—what
did I just do or say that came across that way? And those are things
that I look for in terms of cultural competence.
YALOM: Yeah, well that sounds very freeing in some sense. Because
I think, I think judging from myself and from others, there’s a fear
around it. There’s a fear, certainly among white therapists, that we’re
going to be perceived as not understanding, as racist, as narrow
minded, as oppressive. And so, this idea that we’re all learning. We’re
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Psychotherapy.net
going to make mistakes. And to have that attitude of curiosity and

questioning sounds like a healthy attitude to carry on with.
SUE: It is, it is.
YALOM: Good. And you’ve certainly modeled that through your
career. And through your writings, being quite open with your
journey, because you’ve had a journey, quite a journey yourself in
coming to where you are, and had a major impact on our field and on
the training of our field. So, I thank you.
SUE: Thank you. I hope so.
YALOM: I thank you for your contribution and I thank you for taking
the time to tell me where you are at your state in this journey.
SUE: Ok, thank you
YALOM: All right.
SUE: All right.
43
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Produced and Directed by: Victor Yalom, PhD
Videographer: Mark Maxwell
Video Post-Production: John Welch
Graphic Design: Julie Giles
Copyright © 2014, Psychotherapy.net, LLC
Special thanks to Derald Wing Sue for his willingness to participate in this
production.
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About the Contributors

VIDEO PARTICIPANTS
Derald Wing Sue, PhD, is Professor of Psychology and Education in the
Department of Counseling and Clinical Psychology at Teachers College and
the School of Social Work, Columbia University. A pioneer in the field of
multicultural psychology, multicultural education, multicultural counseling
and therapy, and the psychology of racism/antiracism, he was the cofounder
and first President of the Asian American Psychological Association, past
president of the Society for the Psychological Study of Ethnic Minority Issues
(Division 45) and the Society of Counseling Psychology (Division 17). He is
author of over 150 publications, 15 books, and numerous media productions.
Sue’s book, Counseling the Culturally Diverse: Theory and Practice, 2012, 6th
Edition, has been identified as the most frequently cited publication in the
multicultural field; since its first edition, it has been considered a classic and
used by nearly 50 percent of the graduate counseling psychology market.
Victor Yalom, PhD, President of Psychotherapy.net, is a practicing
psychologist and group and couples therapist in San Francisco, CA. He also
contributes therapy cartoons to Psychotherapy.net.
MANUAL AUTHOR
Shirin Shoai, MA, is a freelance writer for Psychotherapy.net as well as a
Marriage and Family Therapist (MFT) intern at the Marina Counseling
Center in San Francisco, CA. She holds a master’s degree in integral
counseling psychology from the California Institute of Integral Studies
(CIIS) and has more than a decade of communications experience at CBS
Interactive, Apple, and other companies.
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Multicultural Competencies Counseling

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Instructor’s Manual

DERALD WING SUE

The Instructor’s Manual accompanies the video Multicultural Competence

Cover design by Julie Giles

Order Information and Continuing Education Credits:

Instructor’s Manual for

Tips for Making the Best Use of the

3. ENCOURAGE SHARING OF OPINIONS

5. SUGGEST READINGS TO ENRICH VIDEO MATERIAL

6. ASSIGN A REACTION PAPER

Sue’s Pioneering Approach to

Sue’s work advances the idea of traditional therapeutic orientations (i.e.,

Additionally, Sue counts the traditional “blank-slate” stance and

Sue also cites three levels of identification or experience that white

for granted as a cultural standard, while minority status stands out as a

In contrast, members of marginalized groups, who regularly come into

In his work at Teachers College, Columbia University, Sue has

In this interview, Sue expands on the origins of his research, variances

Can you think of contexts in which naming racial difference might be

13. Self-disclosure: To what extent do you use self-disclosure with your

Reaction Paper for Classes and Training

Related Websites, Videos and Further

RELATED VIDEOS AVAILABLE AT

personal counseling. One thing that I discovered was that much of

several important things that really jarred my concepts about

a certain amount of insight. That is that you’re considered mentally

these for native speakers, or non-native speakers?

not comfortable going to the therapist for help in any respect.

individuals that we have all three levels of identity. We have a universal

image as good, moral, decent human beings.

uncomfortable, that perhaps there’s a disconnect that is going on here.

social/political. Which many of my colleagues really don’t want. What

is made clearly, that you understand. It goes to another saying that

wrong, they tend to feel guilty.

competence isn’t simply reading a book. Acquisition of knowledge—it

YALOM: I could see there would be a lot of resistance to people going.

to you—their presenting a racial issue, was that, can you possibly

University is consistent. It consists of—for a master’s level students,

occurs through the mass media, through education, significant others

statement, the congregation says right on, say it again.

skills, of how you relate to a client, many African American clients

what’s going on. He came in to the session, it was not a student, he

videotaping is really powerful to give them insights into how they

going to make mistakes. And to have that attitude of curiosity and

Earn Continuing Education Credits for

About the Contributors

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