MCT and Addictions

Running head: MCT AND ADDICTIONS

Multicultural Counselling in an Addictions Setting By Amanda Waters University of Calgary

MCT and Addictions Multicultural Counselling in an Addictions Setting Working in an addiction setting means working with clients from a variety of backgrounds including socioeconomic status, age, and culture. One could argue that because we are addiction counsellors we should only focus on the addiction itself, regardless of the clients background or the root cause of the addiction. Working in a rural community also means we have a number of First Nations clients seeking help for their addiction from our office. Some counsellors choose to overlook their culture as an important piece to their recovery because they view addiction as the same thing whether you are Caucasian, Asian, or First Nations. These counsellors typically focus on the fact that we are all human and that our bodies all react the same way to substances. Simply put, a Caucasian client becomes intoxicated the same way a First Nations client does. Culture is not seen as being a part of the process of addiction or recovery, it is entirely separate. These counsellors, in my opinion, tend to view addiction treatment as linear rather than circular. They see it as the client has a problem with alcohol, so we should get the client sober and then they will move on. The clients history or identity has nothing to do with getting the alcohol or other substances out of their system and reducing cravings. The argument I hear most often is that it doesnt matter what happened to get here, what matters is the present day. In this paper I will focus on disputing these beliefs and making a case for including multicultural counseling in addiction settings. The primary focus will be on working with First Nations clients as they account for a large proportion of the addiction case load (McCormick, 2000).

MCT and Addictions Synthesis of the Literature on Central Issues in Multicultural Counselling Multicultural counselling, or culturally sensitive counselling, is still relatively new to the field of counselling and has only been introduced to graduate students in recent years (Sue & Sue, 2003). The term multicultural counselling means using a therapeutic approach that is consistent with the life and background of a client to best serve their needs (Corey, Corey, Callanan, 2007). Its purpose is to clarify the role that culture plays in the origin, expression, and resolution of problems. There are several definitions of culture, but for the purpose of this paper we will define culture as a group of people who share similar backgrounds, worldviews, values and beliefs. One of the first and most important things all counsellors must take into account is their own biases and unintentional racism. Unintentional racism is subtle and unconscious, but also very dangerous as it happens without the counsellor realizing it. Counsellors are human and should never underestimate the power of their socialization. Counsellors who are unaware of their own bias may actually do more harm to their clients, even though they are well intentioned (Corey, Corey, & Callanan, 2007). This is a rude awakening, in my opinion, for many counsellors as we enter the field with the

hopes of helping others. What we dont always take into account is that many of us have grown up in sheltered lives where weve only known our own culture and assume that everyone shares our points of view. This is referred to as cultural tunnel vision and its imperative for counsellors to face it and break out of the tunnel (Corey, Corey, & Callanan, 2007). A good example of cultural tunnel vision for many counsellors is working with First Nations clients. Its easy to forget that First Nations history and culture is quite different from other parts of Canada and that they have an entirely

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different perspective. I know that this was especially true for myself when I first entered the work force in a group home for teens with mental health issues. I remember working with a psychologist who was convinced that a young person in our home had schizophrenia as he often talked about having visions. It took me some time to realize that this young person did not have schizophrenia, but was embracing his First Nations culture and participating in ceremonies, which lead him to have visions. This is a good example of a case why counsellors need to expand their knowledge of a culture before jumping to conclusions. The combination of cultural tunnel vision, lack of self-awareness, and unintentional racism can easily lead to ethnocentrism in counsellors. This is especially common for counsellors who work with the First Nations people who do not have proper cultural training. France, McCormick, and Rodriguez (2004) emphasize that the reason why many counsellors are not successful in working with First Nations clients is because of their lack of understanding of the history and effects of oppression the First Nations people have faced in Canada. Culturally competent counsellors should also be aware of their emotional reactions towards cultural groups that are different from their own (Corey, Corey, Callanan, 2007). This means there is a need for counsellors to examine our own prejudices and mindsets. Moreover, to combat ethnocentrism counsellors should develop knowledge about how oppression, racism, and discrimination have affected the client and others who identify with the same culture (Corey, Corey, & Callanan, 2007). Frideres and Gadacz (2008) explain that being white in Canada is so normal that we dont even realize that we view people of other ethnicities as different. Being unaware of the privilege that comes with being white in Canada (or the United States) can easily lead to

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ethnocentrism (Kiselica, 1999). Furthermore, white people are generally trusted and give a good first impression whereas minority groups tend to be judged as less worthy or even dangerous. Many of my First Nations clients tell me they are often first perceived as untrustworthy and up to no good. Being ethnocentric will lead to a counselling

relationship that lacks balance and appears to be a case of expert versus non-expert which will be of no help to the client (Saracuse, 2004). This will not help the client to feel they are capable of recovery and could emphasize their need for substance use. Finally, counsellors should be aware of how their communication style and intervention strategies may be perceived by other cultures (Saracuse, 2004). For example, I worked with a young First Nations man about a year ago who never looked me in the eye. At first this threw me off because Caucasian Canadians see maintaining eye contact as a sign of respect and attentiveness. For this client, however, not looking me in the eye meant he was showing me respect. Being a multicultural counsellor means expanding ones repertoire of skills and constantly seeking out knowledge of other cultural groups. Doing so will help put the role of therapy in context for the client and will better serve his or her needs. Its important to set out goals with the client that are consistent with his or her values and respects their life experiences. This includes, but is not limited to, considering individualism versus collectivism, age, language, race, religion, sexual orientation, socioeconomic status, and family (Corey, Corey, Callanan, 2007). In summary, practicing multicultural counselling involves three things that I will focus on in the first part of this paper: The first is the counsellor must be self aware of assumptions, values, and biases. The second is the counsellor must expand his or her

MCT and Addictions knowledge and understand the worldviews of different clients. The third is that counsellors must develop the necessary skills to work in multicultural settings, which includes developing and practicing a variety of interventions and strategies (Saracuse, 2004, p. 257). Critical Analysis of the Relevance and Importance for First Nations Culture to be Integrated in an Addictions Setting According to the Canadian Centre on Substance Abuse (CCSA), addiction

professionals are bound to Provide respectful, equitable and effective services to diverse populations as defined by culture, age, gender, language, ethnicity, socio-economic status, legal status, health, ability, sexual orientation, type of mode of substance use, etc (CCSA Behavioral Competencies, 2010, p. 6). This includes, Possess[ing] considerable knowledge and understanding of historical, cultural, spiritual, political, and socio-economic issues that affect diverse populations and develop effective, inclusive, and respectful working relationships (p. 26). When a counsellor examines the history of the First Nations people in Canada, they dont have look very far to discover a long and painful journey of oppression and discrimination. Its vital to understand this history because many First Nations people have used alcohol or other substances to numb the pain (McCormick, 2000). Its also important to note that the residential school system played a large role in the cultural genocide of First Nations people. McCormick explains that cultural breakdown often leads to alcohol and drug use and that we as counsellors need to have a strong understanding of how history plays a role in the lives of First Nations people today. In other words, it is not enough to look at the addiction as a problem of today, we must get to the root of the problem and break the cycle.

MCT and Addictions Insensitive counselling can actually lead to more oppression, which is the opposite of why people come to therapists (Sue & Sue, 2003). Counsellors are seen in the community as being role models and are a part of setting the standards for equality. How could we expect our clients to treat themselves and their partners with respect if we dont treat them as equals? It is a part of our job to demonstrate what a healthy life can look like which is impossible if we are ethnocentric or racist. One part of the reason why many First Nations clients drop out of counselling is because they dont feel valued by their counsellor (France, McCormick, & Rodriguez, 2004). Joseph Gone (2010) explains that when counsellors at treatment centers for addictions respected their clients by allowing them to speak outside of their allotted one hour of counselling they did better in treatment. Clients felt that they were able to take

their time and that their counsellor truly cared for them because they did not rush them to speak. This clearly demonstrates a respect and value for First Nations people that other Eurocentric counselling does not do. In our practice we cut off clients at one hour and call it inappropriate for them to seek us out at any other time. This clearly goes against what First Nations people describe as respect and value (Gone, 2010). Working for a publicly funded addictions agency means being mandated to provide relevant and meaningful services to the public. This includes taking into account the different cultures and ethnicities that reside in our communities. For example, First Nations people represent 3-6% of the Canadian population and are the fastest growing minority (France, McCormick, & Rodriguez, 2004). This may not seem like a large number, however, it accounts for over 700,000 people that we are mandated to serve to the best of our abilities. First Nations people are also six times more likely to die of

MCT and Addictions alcohol related causes than the rest of the population making it even more important to

best serve their needs (Sue & Sue, 2003). This means providing services that are relevant and effective, which includes multicultural counselling. It also means addiction counsellors should have the skill set and knowledge to best serve the needs of all our clients and be willing to adapt our style if need be (Corey, Corey, & Callanan, 2007). Saracuse (2004) discuses the importance of making therapy meaningful and relevant for the client and emphasizes the need to understand the clients perspective. Because the field of addiction counselling is centered on where the client is on their journey of recovery, we must meet the client at whatever point he or she is at in order to increase the chances of success. In other words, we must make counselling meaningful for the client. As Canadians we tend to view people only in their individual context, we dont look beyond their own accomplishments or values. Working with First Nations clients, however, means looking at the world from their point of view which tends to be very different from the Caucasian perspective. First Nations people view themselves not as a single entity, but as a part of a family, group, and the universe (Saracuse, 2004, p. 256). Therapy is much more likely to be successful if the counsellor understands the clients life experiences and uses modalities that are consistent with his or her perspectives of how they view addiction (Saracuse, 2004). For example, according to Brady (1996), many First Nations people view addiction to be caused by outside forces such as the introduction of alcohol by the European settlers. This interrupted the connection between the spirit and the body of First Nations people, making healing very difficult (McCormick, 2000). In order for healing to occur, First Nations people must win the war against the spirit of alcohol and reconnect their body with their spirit. If an

MCT and Addictions addictions counsellor did not understand this point of view, it would make healing even more difficult and the client would continue to experience oppression thus strengthening the spirit of the alcohol. However, if a counsellor gives the client the opportunity to express how they see the problem, they will be encouraged and strengthened in their recovery because it will be meaningful to them thus increasing their chances of wellbeing. First Nations people already have many of the answers that will help them on the journey of recovery. For example, we know that problems with substance use do not appear out of thin air, they are caused by a lack of self-esteem and cultural identity, lack

of positive role models, abuse, social pressure and hopelessness (Sue & Sue, 2003). This fits in perfectly with the First Nations belief of the Medicine Wheel which views the person as having four parts that make them whole: Physical, mental, emotional, and spiritual (Gone, 2010). It makes sense to use what is already familiar to the client and help therapy to be relevant and meaningful to them. As mentioned earlier, it is important for counsellors to develop a wide variety of skills and interventions for working with culturally diverse clients (Saracuse, 2004). Counsellors tend to be a lack of insight into the First Nations clients behavior towards the counsellor and misinterpret their behavior as disrespectful. We need to understand that although it could be argued that its difficult for anyone to talk about addiction issues, it is particularly difficult for First Nations clients to talk about them with strangers. I refer to this as the square peg round hole syndrome in addiction counselling. This occurs when the counsellor is trying to make the client fit into a certain mold that the counsellor is used to. I remember when I first starting working in addictions, I had a young First Nations man referred to me by probation. The first few

MCT and Addictions 10 sessions he made no eye contact with me and wed often sit in silence that felt uncomfortable for me. Thankfully, however, I consulted with a coworker and learned that this was a sign of respect and honor and would eventually help lead us to a good working relationship. Had I not realized that this was a case of a discrepancy in culture, I would have made the client uncomfortable by rushing him to speak which most likely would have driven him away and reinforced the notion that white people do not respect First Nations people. Finally, when we compare the rate of success for recovery programs that include spirituality versus programs that dont we see a large discrepancy (Brady, 1995; McCormick, 2000). First Nations clients have a high drop out rate when treated in mainstream health centers whereas they tend to have higher success rates at First Nations run programs (McCormick, 2000). It is thought that differences in value orientations between Aboriginal [First Nations] people and mainstream health service providers lead to different beliefs concerning the causes and solutions of mental health problems (McCormick, 2000, p. 26). Programs such as Poundmaker Lodge in Alberta and Round Lake Treatment Centre in British Columbia, however, have incorporated traditional First Nations ceremonies into their treatment programs, including the sweat lodge ceremony, smudging, the round dance, and drumming (Brady, 1996; McCormick, 2000). These programs have seen high success rates indicating they are effective and meaningful for the clients. Another example is the community of Alkali Lake, British Columbia, which sought to reduce their alcoholism rate of 95% by inviting elders to lead them in traditional ceremonies and view the problem as a community problem rather than an individual problem. The program was successful and the communitys alcoholism rate

MCT and Addictions 11 dropped to 5% in ten years (2000). These programs take the stance of viewing recovery as a group process rather than an individual process. They are also careful to not impose any White solutions on the clients which empowered them to embrace their culture (Sue & Sue, 2003). It would be unethical for a counsellor to disregard these numbers and not provide the most effective services for his or her First Nations clients. Summary As addiction professionals, we are mandated to best serve the needs of our clients and of the community. We are ethically bound to provide services that are respectful, effective, and relevant for every client we see. This means keeping up with current research and literature in the field of addiction counselling and constantly striving to provide the best services possible. We are meant to meet the client at whatever point he or she is at on their journey of recovery and support them along the way. Studies have proven time and time again that providing multicultural counselling for First Nations clients are much more successful than Eurocentric strategies (McCormick, 2000). Furthermore, if a counsellor fails to provide meaningful and relevant services for the client, he or she may actually be contributing to the oppression First Nations people have suffered for hundreds of years in Canada (Saracuse, 2004). Moreover, we must remember that we are serving every individual in a unique way. Everyone has a different story and perspective and in order to be effective in our skills we must be able to see the world from the clients point of view (2004). Counsellors are supposed to set the example for treating others with dignity and respect and pave the road for equality (CCSA, 2010). By not providing services that honor the culture and history of the First

MCT and Addictions 12 Nations people, we are setting the example that this is acceptable. We must act out what we say we believe in and show Canadians what equality is all about.

MCT and Addictions 13 References Brady, M. (1995). Culture in treatment, culture as treatment: A critical appraisal of developments in addictions programs for indigenous North Americans and australians. Social Science & Medicine, 41(11), 1487-1498. Retrieved from Elsevier SD freedom Collection Canadian Centre on Substance Abuse. (2010). Canadian centre on substance abuse. Retrieved February, 2011, 2011, from Corey, G., Corey, M. S., & Callanan, P. (2007). Multicultural perspectives and diversity issues. In G. Corey, M. S. Corey & P. Callanan (Eds.), Issues and ethics in the helping professions (7th ed., pp. 110-152). Belmont, California: Thomson Brooks/Cole. France, M., Honore, McCormick, R., & Rodriguez, M. d. C. (2004). Issues in counselling in the first nations community. In M. France Honore, M. d. C. Rodriguez & G. Hett (Eds.), Diversity, culture and counselling: A canadian perspective (1st ed., pp. 5976). Calgary, AB: Detselig Enterprises Ltd. Frideres, J., & Gadacz, R. (2007). Aboriginal peoples in canada (8th ed.). Toronto, Ont: Pearson Prentice Hall. Gone, J. P. (2010). The red road to wellness: Cultural reclamation in a native first nations community treatment center. Am J Community Psychology, 27(1), 187-202. doi:10.1007/s10464-010-9373-2 Kiselica, M. S. (1999). Confronting my own ethnocentrism and racism: A process of pain and growth. Journal of Counseling & Development, 77(1), 14-17. Retrieved from ISI Web of Knowledge

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McCormick, R. M. (2000). Aboriginal traditions in the treatment of substance abuse. Canadian Journal of Counselling, 34(1), 25-32. Retrieved from Saracuse, J. (2004). The positive effects of integration of multicultural counselling theory into counselling practice. In M. France Honore, M. d. C. Rodriguez & G. Hett (Eds.), Diversity, culture and counselling: A canadian perspective (1st ed., pp. 255-264). Calgary, AB: Detselig Enterprises Ltd. Sue, D. W., & Sue, D. (2003). Counseling the culturally diverse: Theory and practice (4th ed.). New York, New York: John Wiley & Sons, Inc.