by Vicente Gannam
This section examines some elements that support the need for greater cross-cultural sensitivity in the counselling profession. It also provides a framework for developing cultural sensitivity. The framework provided is based on concepts proposed by Sue and Sue (1990) and later revisions by Sue et al. (1992). It also explores ways to apply those concepts to problem gambling. In addition, this chapter includes a brief examination of different ways cultures perceive the counselling process, and how these differences may affect the counselling relationship.
This section does not offer a final solution, or a “how to” guide to resolve the complex work of counselling problem gamblers of specific cultural groups. However, it points at directions/elements that professionals need to be aware of when treating problem gamblers of cultural backgrounds different from their own. This chapter does not include strategies to be used with members of particular groups to avoid originating stereotypes and/or generalizations about specific cultures. Instead, it offers guidelines to assist professionals develop a level of cultural awareness that will increase their competency when working with members of any ethno-cultural group.
As counsellors, we have much to learn from and about our clients. When counselling a person from a different background, there is even more to learn. Cross-cultural counselling involves recognizing the existence of an added dimension and creating the necessary conditions for its exploration. In the next few pages, I will present some thoughts and examples of how that has become visible in my work with problem gamblers.
The Need for Cross-Cultural Awareness
The changing makeup of canada
According to Statistics Canada (1997), the number of Canadian residents who belong to ethno-cultural groups other than Canadian has grown significantly in the past decade. Over one million new immigrants came to Canada between 1992 and 1996. Toronto is among the most targeted destinations for newcomers. Consequently, approximately one-third of Toronto’s total population of 4,232,905 is composed of minorities. The rate is considerably lower in areas surrounding Toronto, remaining around the 8% mark in places like Hamilton, Kitchener and London, even going down to approximately 3.5% in the St. Catharines–Niagara region. For the province of Ontario, the rate is around 16%, also lower than in Toronto. This rapidly changing composition of the Canadian population is only one of many elements supporting the need for cultural sensitivity. This chapter will consider several additional elements that confirm the crucial role of cultural sensitivity in therapy.
What the research can tell us
In spite of such cultural diversity in Canada, studies about ethnic groups and problem gambling are scarce. As such, there is very little information available on prevalence rates within the various ethno-cultural communities and how those rates compare with those in the general population. Although there is one study suggesting that problem gamblers are more likely to be non-Caucasians (Volberg, 1996), specific numbers about each community do not seem to be available.
At the time of this writing, I am aware of very few studies in Canada that focused on gambling and ethno-cultural groups. Three of these studies were released last year, which might indicate that interest in this area is growing. The first was conducted by Chinese Family Life Services of Metro Toronto, in 1998 (Kwan, 1998). This study indicates that the prevalence of gambling activities within the Chinese community seems to be lower than within the general adult population. In addition, it presents the rate of problem gambling at 3.1%, within the range estimated for the general population (between 3% and 5%) and of pathological gambling at 2.6%, only slightly above the general population, where it is estimated to be between 1% and 2%.
Another study conducted by the Somerset West Community Health Centre in 1998 looked at problem gambling in the Asian community in Ottawa/Carleton. This study did not provide prevalence rates, but examined the extent of problem gambling within three Asian communities (Chinese, Vietnamese and Cambodian) in the Ottawa region. In addition, it considered the applicability of an intervention model developed by Chinese Family Life Services of Metro Toronto for the communities being examined.
A third study was conducted in Toronto to explore cultural perceptions on gambling and help-seeking among East Indians, Jews and Italians (Gannam, raw data). Due to sampling limitations, this study points to possible areas of cultural differences among the three groups, without, however, being conclusive. Four additional studies conducted earlier are included in the resources section.
Stress is higher
Another element suggesting the need for cultural sensitivity is the social (influenced by mass-media portrayals), legal and financial climate in which many ethno-cultural groups find themselves. Ethnically different groups live in a particularly stressful reality. The normal stresses of life are compounded with problems such as immigrant status, prejudice, discrimination, underemployment, linguistic barriers and generational conflicts over acculturation. Moreover, distress may also originate from frequent moves, lack of upward mobility, inadequate family support, and an inability to meaningfully relate to cultural institutions such as churches and schools (Berg-Cross & Chinen, 1995).
Lack of knowledge
In addition to heightened stress levels and the rapid growth of ethno-cultural groups, a general lack of cultural education and awareness contributes to a gap between the needs of ethnic groups and the services provided. As pointed out by Young and Marks (1986, cited in Berg-Cross & Chinen, 1995), mental health workers are often unfamiliar with the cultural context of the many different clients with whom they work. Many of the institutions in the field, as well as the professionals they employ, often perceive and interact with culturally diverse people from a white middle-class perspective (Ho, 1987, cited in Congress, 1994). Besides, information about diverse clients often creates as many stereotypes as it dispels, and leaves counsellors with little idea of how to effectively counsel across cultures (Congress, 1994). In addition, as pointed out by Volberg (1996), lifetime problem gamblers are significantly more likely to be male, under 30, unmarried, and non- Caucasians. Knowledge of other cultures contributes to a service provider’s cultural competence. “Cultural competence” will be discussed in a later section of this chapter. In response to the issues surrounding a lack of education about other cultures, professionals in the mental health field need to try to increase their awareness of various cultures and multicultural issues, and to create an environment that is favourable to their exploration.
The Need to Assess “Level of Acculturation”
Cultural factors should be considered whenever a counsellor from one cultural background interacts with a client of a different cultural background. However, it is essential that counsellors first consider the client’s level of acculturation. Acculturation is the process of learning a new culture that happens as a result of the contact between people of different ethno-cultural groups (Grieger & Ponterotto, 1995; Paniagua, 1994). Ideally, as individuals go through this process, they learn elements about a new culture and harmoniously integrate them with elements of their own culture. The need for culturally sensitive interventions will depend on the extent that clients have moved along the process of acculturation. After assessing the level of acculturation of an individual client, a counsellor can then determine to what extent cultural differences need to be explored. For example, as we shall see later in this chapter, clients from some non-western cultures usually are less comfortable with counselling. The need to explain elements of the counselling process is more pressing for clients who have not yet learned the main culture and integrated its values into their own than for clients who have become more comfortable with the values and attitudes of the main culture.
There are now roughly 50 different instruments to measure dimensions or levels of acculturation as well as ethnic identity development (Grieger & Ponterotto, 1995). One example of such tools is the culturagram, which focuses on different aspects of culture and was designed to help professionals understand different aspects of culture in terms of a specific family (Congress, 1994). This tool is useful for practitioners who feel comfortable with a semi-structured interview format.
A word of caution is needed when considering client acculturation. While in theory acculturation may be a positive practice, dominant cultures often suppress the “other” cultural influence and counsellors may continue to perceive their clients based on their own learned culture. Increasing cultural awareness, as outlined earlier, is just the beginning of fighting this.
In my practice, I usually employ an unstructured approach. I start by exploring with clients how they perceive themselves ethnically and culturally. This self-identifying process plays a significant role in maintaining a client-centred environment. Counsellors need to find their own ways of exploring the areas suggested, depending on their style, approach, comfort level, and of course, the client. The questions below are provided to illustrate one means of exploring acculturation during counselling. The following example involves a client from an Italian background.
“How much of yourself do you see as Italian and how much as Canadian?” (can ask for specific percentages)
“What are the pieces in you that seem Italian?” “…Canadian?”
“How do you feel when you are identified by others as being Italian?”
“Can you speak Italian?”
“How do you feel about (not) being able to speak it?”
“How involved with the Italian community are you?”
It is also important to explore how clients see their own culture in relation to the host culture, and their experience of racism, prejudice. Listen to and validate their stories about these, and talk about how they have internalized the reality of being part of a Canadian minority group. I would also explore areas such as place of birth, language spoken at home, family’s proficiency in English, and, when appropriate, date of immigration, circumstances of immigration, life before and after immigration, their feelings about not being able to practise their profession (for example, someone who was a dentist in the country of origin, but has to work as a cab driver). These are culture-specific questions that do not usually come into play when counselling someone who belongs to the host culture. Cross-cultural counselling, for problem gambling, and for any other problem, is about creating the space where these and other unique cultural aspects of clients can be verbalized, validated, respected and accepted.
How level of acculturation affects treatment planning
Assessing clients’ level of acculturation also assists counsellors in evaluating the effectiveness of various strategies and in choosing what direction to take.
Case example 1: Exploring someone’s immigration and/or pre-immigration history can also assist practitioners find elements in a client’s history that can increase the understanding of problematic gambling behaviour. One of my clients, from a Latin American background, had grown up in a very wealthy family in South America. For him, coming to Canada meant losing the comfort and the status of belonging to the higher social class. In his own words, “before coming to Canada all I had to do was ask for what I needed…I used to say, “Bring me a glass of water!” and one of the maids would bring it to me…I did not have to lift a finger.” As it become clear during his counselling sessions, his gambling was an attempt to regain the same standard of living he had had in his country of origin. In this case, strategies included dealing with the losses that had occurred because of his move to Canada, as well as looking at how the gambling was increasingly taking him away from the lifestyle he longed for. In this, as in many other cases, assessing level of acculturation initiates a process in which clients start to evaluate and understand the changes in their status (from dominant to minority group, from high to low class, from powerful to powerless, from educated to uneducated, from fluent to not being able to communicate, etc…) caused by immigration.
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