Ethical Dilemmas in a Multicultural Setting Silvia Gale “An ethical dilemma exists whenever there are good but contradictory ethical reasons to take conflicting and incompatible courses of action. ” (Kitchener, 1984 p. 29) “There is no legitimate way to avoid these ethical struggles. They are part of our work”. (Pope & Vasquez, 2007 p. 1 25). Introduction Cultural competence is fast becoming the new competence in counseling (Barnett 2009, Barnett 2000).
As society changes and minorities become more prominent in our society, professionals are ethically bound to learn new skills that help them deliver a culturally sensitive service to clients questing assistance in the helping profession. (Riddle, Lied, Hill, & L I, 2001) throw light upon the “many limitations” of different codes of ethics that reflect the values of the dominant culture. A decade before (Sue & Sue 1990) argued that ethical guidelines are by no means neutral and have at best suppressed diversity and often pathologists the behavior of minorities.
According to (Sue & Sue, 1990) this “westernizes” set of ethical values falsely put practitioners’ minds at rest for not advocating for a culturally sensitive ethical thinking that takes into account the perspective of minorities and diverse cultures These issues become more complex when one takes into account concepts of acculturation (Baptists 1993)-when migrants decide to relinquish some or most of their unique cultural values in order to adapt to the host society and Bicameralism (Berry 1 997) the combination of migrants and host cultural values.
Different individuals integrate values to different degrees (Berry, 1997). Further sensitivity and culturally sensitive reflection is also necessary when a client from an ethnic minority comes into the counseling room with issues pertaining to gender or sexual identity. Ethical Dilemmas in Multicultural Counseling 2 For the purpose of this paper I have chosen TTY. Or case studies to illustrate the ethical dilemmas encountered in working within the area of multi-cultural/ cross cultural/trans-cultural counseling.
These case studies have been slightly altered to protect confidentiality. Will be concentrating exclusively on the ethical issues and only touch onto techniques and other work done with these clients. These case studies are part of my work in the area of asylum seekers, an area am looking forward to going back into after I finish my studies. The case of Dodo. Dodo is a French-speaking Congolese woman who within group and individual sessions transformed herself from a meek, submissive dependent woman to a beautiful self assured woman.
She retained certain aspects from her culture, especially around her role as a devoted and relatively submissive wife but acquired other competencies to help her integrate into Our society. She gained confidence in herself, started to communicate more effectively with her husband and those around her and startled her male children by assigning household chores to all family members including her male children. The transformation within reflected herself in her outward appearance – she took if her “African” extensions and started to wear her hair short, she upgraded her clothes and put on make up.
She remained very reserved and polite but she worked hard to look at men and people in authority rather than lower her eyes and bend her head. Downwards whilst they spoke to her. She learnt how to communicate assertively and to ask questions and seek instructions when needed rather than obey without question until she could not bear it and 3 continue to leave one job after another because employers kept taking advantage of her meek behavior. In the initial sessions she likened herself to lamb and a dove.
By the end of the counseling process she became a deer but retained the dove (peacemaker) within her. Petersen (1997) stated that most counselors have not been sufficiently prepared to interpret the ethical guidelines with sensitivity to racial and ethnic minority groups. (Roomer, 1 985) highlights the need that counselors view the identity and development of culturally diverse people in terms of multiple, interactive factors, rather than a strictly cultural framework. Working with Dodo was a challenging experience which brought about many ethical dilemmas.
Such dilemmas often centered around evolving her personal autonomy in the context of her ethnic origin within the culture of dependency and interdependency that collective cultures proclaim. I often found myself reflecting on how any abrupt changes could damage her rather than benefit her as nonconformity to gender roles and stereotypes can have a devastating effect on females who may be stigmatize, ostracizes or even “socially erased” in particular cultural contexts (Roomer, 1985).
I often pondered upon what in one culture could be beneficent would result in an act of maleficent in a different cultural context. Trivet to be faithful to my client, to move at her pace and to go to the places where she wanted to go in the process of counseling. I urged and empowered her to teach me her cultural norms, her traditions and the intricate fabric of her cultural network that I may understand her internal conflicts when she started to grow in the understanding and appreciation of other cultures which valued women empowerment.
African culture has a 4 strong communal orientation. It is a deeply embedded value that individuals do not exist alone, but owe their existence to their ancestors, hose unborn, the entire community, and all of nature (Myers, 1988). The concept of “bunt” or the collective is a concept of a collective identity which is diametrically opposite to the westernizes concept of individualism on which the counseling profession is built. (Boston, 2000).
A sense of ethical- mindfulness (Bond 2007), alerts the culturally sensitive clinician to tread very carefully and cautiously into the unknown waters of multicultural counseling and to understand the implications of change in the concept of collectivities (Karee & Littleton,1 992). Working with Dodo entailed teaching her to how to assess and access her ultimate identities in different contextual settings (Hansen et al, 1992) and to become more aware Of her racial/ethnic identity as well as her gender identity and its meaning in her cultural cohort and in different cultural contexts (Petersen, 1997).
These reflections ensured that Dodo learns how to step inside and fit into the cultural context she wished to operate in. Dodo had to wait for her husband Gaiter’s readiness to work through her process of change. It was very important that understood and respected my client’s implicit need and that was continuously alert to rebalanced the power factor s during the therapeutic process too had become very important for her even more so in the African tradition of “bunt”.
Dodo insisted that I had become part of her ancestral identity. She used to call me “mama” and “mama” and would persevere in declaring that ‘I;eve are now bonded and live as one”, which of course creates difficulties in the westernizes concept of client autonomy. Adrienne and Maintain (1989) suggest that in transmutable work the way to work within these 5 circumstances is best not to focus exclusively on the client but to work with the client within the principle of bunt.
I have found group counseling to be relatively near to this principle as long as the group members are carefully chosen and would not come from tribes that are at war with each other. Working within a group dilutes the intensity of meaning as the bunt reallocates itself into a collective concept. In Dodo’s case, her husband Gaudier was also part of the group and therefore he could understand and appreciate better the transformation process that his wife chose to embark upon.
Another ethical dilemma I encountered with my work with Dodo and other African women of childbearing age was their expectation to attend to deeding, christenings and other important celebrations. Petersen, (1995) states that ethics should take cultural perspective into account and insists that what constitutes ethical behavior in one culture might be unethical in another and what might guard relationship boundaries in one culture could interfere in the therapeutic alliance in another cultural setting.
Wiggins-Frame and Barbarianisms, (2005) insist that counseling approaches which are absolutist and rule bound can actually be dangerous in a multicultural ethical perspective as they disrespect the very clients that ethical guidelines aim to protect. Mutinously sought supervision about this dilemma both from the clinical aspect but also from tribal leaders like the pastor (in Dodo’s case) and the imam with whom would discuss implications of turning down invitations.
I have found from experience that it is very difficult to decline such invitations at the beginning of the counseling relationship but grad ally as trust is gained and cemented in the 6 African bunt tradition the clients start to understand and even respect the different cultural traditions and the ethical obligations of their counselor. They also gradually understand that a counseling allegations has a beginning and an end.
Work towards the purpose of ending a therapeutic relationship should start at the very first session, although it must be kept in mind that there is a likelihood that at this early stage the concept of termination might interrupt the process of bonding in this cultural context but out of the universal principle of trust and fidelity towards the client and the counseling relationship I have always felt that I would rather take a calculated risk and inform the client of termination rather than lead them onto the false hope that counseling would always be available.
Kamala Kamala comes from the Sudan Hausa Muslim tribe. He was about 23 when I started seeing him. During a particular session it emerged that Kamala was taken away from his mother’s house by his father at the early age of nine years into a military training camp where he was trained in warfare. Kamala was made to believe that his life was not important but if he sacrificed his life for the collective ideology his worth would escalate in the eyes Of Allah and in the eyes of the community.
He however had a lot of guilt feeling and ended up deserting the army as he could not “bear to listen to the sound of guns ring in my ears”. He suffered from frequent nightmares where he saw himself being used as a human bomb that blew up a whole building full of innocent people. In the dream his mother was crying because she lost her son and his father was overjoyed as his son’s martyrdom 7 guaranteed the famish salvation in heaven and the family’s honor in their community.
To complicate matters (in his cultural context) Kamala was attracted to men and had been abused many times whilst serving in the army by other soldiers who would not acknowledge their attraction to him for fear of being stigmatize at best and killed at worst. The Muslim Hausa culture which includes tribes from some parts of Sudan, Nigeria, Ghana and Liberia is one of the very few cultures that allows homosexual activity in African (Studio, 2005). Other cultures (e. Senegal or different parts of Sudan persecute gay men in their life and death by sending them to prison, beating them, or stoning them (sometimes to death) and digging up and desecrating their dead bodies; creating a culture of extreme homophobia and fear for gay people throughout Africa (Sprinkle 2010). Jamb’s confused sexual identity together with the many hardships he suffered made him consider suicide any times but this type of suicide ideation deeply disturbed his sense of cultural belonging and connectivity and made him sink deeper into a helpless state of depression.
Multicultural considerations in working with Kamala. 8 Working with Kamala compared to the work done with Dodo, in that both clients were being given English lessons alongside counseling as part of an E. IS. Social fund program and conversations in counseling continued to consolidate acquisition of the English language. Initially both clients were seen within a group context which was facilitated by myself and a male co- worker. Individual sessions were also offered along the counseling journey on a need basis or whenever a client sought such one to one work.
With the help of supervision and peer supervision in Jamb’s case a decision was taken early in the counseling process to offer him one to one sessions due to diverse reasons which included confidentiality issues which could not be guaranteed within a group SETI Eng. Kamala was left free to choose the counselor of choice. He chose me because he said that he experienced me to be less biased and judgmental. Also suspect that it was easier to discuss his gender issues with me because of transference that he experienced with my male counterpart.
In Jamb’s case an interpreter was recommended in the first sessions but Kamala refused as he said that listened and understood him “from the heart”. He also implied that he would not feel safe with anyone of his own country listening to his story. In line with the principle of autonomy I decided to follow ( Du Chit, Growler & Scheme 1 998) advise : The counselor therefore “respects, values and appreciates the client and his/her own culture, resourcefulness and skills and allows the client to show the way to respectfully crossing the border into his/ her frame of reference and world” p. 9 His language gradually got better echoing Costa Beverley (2008) insistence that the therapeutic space may be the only safe space Ethical Dilemmas in Multicultural Counseling 9 where the client can trust to develop his language skills without being judged and that language problems can be overcome through the combined effort of the counselor and the client. Whenever Kamala felt stuck, I used to ask him to speak in his mother tongue and then ask him to translate the content to me afterwards. I found myself nearly always managing to grasp a fair amount of the content from his nonverbal prior to his translation.
There were times when he drew pictures Of his experience which Were too difficult to verbalize even in his own mother tongue. These would most likely be account of mass murder and torture that he had seen inflicted on his people. I asked him to teach me a couple of words in his mother tongue that I may use when he was distressed and withdrawn. Repeating these words which meant “courage” and “you are a good person” seemed to help soothe him and also helped assure him that I was not being judgmental even when he recounted experiences of his own reiteration to the actions he received. Sue & Zane, 987) insist that credibility is one of the key tasks that a white counselor has to strive for at the earliest stages of the counseling process in multicultural counseling. If the client suspects any racist tendencies or any problem on the part of the counselor regarding cultural traditions, religion, sexual identity issues etc the counseling process will never take off as the client will not come to trust the counselor (Locke & Selkirk, 1999).
However if this is superseded the likelihood is that the therapeutic alliance will guide the counselor to engage in a way that helps foster the personal growth that the client would ant for themselves. 10 do believe that my work with Kamala was successful because the client was convinced Of my fidelity, congruence and unconditional positive regard for him. However I also made sure that in the early stages of the counseling process I discussed with Kamala the remits of confidentiality.
I was very clear that I was bound to break confidentiality in the perceived harm to self or perceived harm to others circumstance. Made sure that he understood me without a shadow of a doubt as this particular case had many safety issues that needed to be explored – namely the issue around harm to self (suicidal ideation) and harm o others (in the context of the dream that he often narrated). There was also the issue of my own safety. Listening to such accounts of horror that Kamala and other members of the group exposed me to vicarious transformation issues which needed to be dealt with in supervisor.
Palmer-Barnes (1998) includes considerations about counselor competence within the ethics around safety. Such competence includes the counselor’s ability to recognize when cases should be referred. Did refer the case to a psychiatrist who however was not at all helpful and without listening much to Kamala decided that his suicide risk was low given his trick religious ideology and warned him against any “fooling around” which would undoubtedly see him locked up at Mount Carmela Hospital.
Kamala was given some antidepressants which he refused to take as he did not trust the “angry doctor whom he perceived as being racist and homophobic. Out of further considerations of safety for myself and my client, I also took care that there were no potentially hazardous objects in the room. A glass coffee table had to be removed from the counseling room as Kamala occasionally hit the table in front of him out of desperation.
I also 11 ensured that was never alone in the building should there be need to call a colleague to contain Kamala, who incidentally was never violent but was sometimes desperate especially when removed from the culture of the army camp he started to realize the extent of his own misconduct and grave actions towards other human beings. I referred him once more to another psychiatrist and this time round he complied with the medical treatment out of trust and fidelity to the counseling relationship.
Kamala has been been relocated to Holland where he joined his mother’s side of the family. He has contacted his mother back in Sudan and was greatly lived to know that she suffered no consequence because of his desecration from the army although his mother told him that his father is very angry at him and does not want to see him ever again. He has learnt to live with his father’s anger and contacts his mother regularly with the hope that she would someday accompany him in Holland. Kamala is slowly recovering his life.
The last time I heard from him he was attending counseling in Amsterdam and requested his counselor to contact me about the work that we did together in Malta. He is living with his partner, a second generation cousin in a small flat and is studying graphical sign. Conclusion: 12 The cases of Dodo and Kamala represent two very different counseling situations and illustrate the diversity of ethical issues and competencies that a counselor encounters whilst working in this relatively new area of counseling (Capsize & Gross, 1985). (Gobo, 1 990, Hicks & Christie, 1 989; Merry, 1 995; Riddle et al. 1 994) highlight the importance of respect for the uniqueness of each individual within his particular group identity. Dodo and Jamb’s stories reintegrate Sods (1996) when he contends that the notion of the “African personality” is very disrespectful towards clients as apart of robbing linens of their own individuality it also has the potential of perpetuating the racist assumption that all Africans are alike. Pettifog (2002) states that professional ethics should be more concerned with human relationships that with abstract rules.
Some of the pre-conditions to work this way are gene nine respect, caring attitude and professional integrity on the part Of the counselor towards fellow professionals working in the field and for clients from diverse cultural backgrounds. This profound respect is reflected in the commitment for the acquisition of competence that ensures respecting the uniqueness of every different client. Clients deserve our utmost respect and it would be indeed unethical to have rigid ethical codes that reflect the dominant values of a dominant culture at the expense of the culture of the minority.
How would Dodo have fared had I not considered her collective culture and insisted on the values of personal autonomy or how would Kamala have fared had insisted on an interpreter and not understood the issues of personal safety that he carried with him from his homeland? Silica (1995) stated that “a White man who listens carefully, sincerely, and completely when people of color speak will ran their respect and, consequently, will be 13 heard” (p. 17). Listening completely to people of color means understanding their value systems and being open to ethical considerations that do not go against the values of their particular culture.
Another assumption which also needs to be challenged concerns the argument that De Santos (2007) brings up in her evaluation of Logo (2005). She noted that most literature being written and made available in the area of ethical consideration and practice in cross cultural counseling is biased in its assumption that the clinician is ‘White” and that Logo’s book although well Ritter does not explore the concept of “black therapist’ in the same way that it explores the stance of “whiteness”; neither does it explore or look into how a black therapist might address issues around “whiteness” with predominantly white clients.
It seems that just as ethical guidelines have been drafted from a westernizes perspective, reflections about ethical adaptations and considerations in the area of multiculturalism also pertain to the dominant culture. Finally as Sue and Zane (1987), reading the literature will never be enough. We need to develop experience and familiarity with individuals from diverse cultural backgrounds and do so with a spirit of acceptance and openness that motivates us to learn from them.
