2015) improved on the previously crafted Multicultural Counseling Competencies (Sue et al., 1992) and provided a foreground for this work within the counseling field, particularly with regard to counselor identity and the helping relationship (Ratts et al., 2016). The MSJCC outline the important role of counselor self-awareness in providing culturally competent counseling (Davis et al., 2018). Awareness of one’s own cultural diversity and how this directly impacts the therapeutic relationship is one aspect of this multicultural model that is often highlighted in research. Additionally, and perhaps fundamental to this process, is also counselor self-awareness of social location and cultural beliefs. Social location is the manifestation of the complex fabric of cultural identity, roles, lived experiences, internal and external forces, and so forth. Counselors account for the nuances of lived experience that a person has that cannot be replicated or fit a prototype. An awareness of diversity addresses the counselor’s or therapist’s openness and motivation to understand more about their own cultures and cultural intersectionalities as well as the cultural intersectionalities that clients bring to the helping relationship (Brinkman & Donohue, 2020). In addition to self-awareness, the MSJCC require evaluation of knowledge and skill regarding cultural competencies, which encourages counselors to engage in a continuous practice of self-assessment (Ratts et al., 2016).
The continuum of cultural competency remains central to the discussion of diversity and inclusion within counseling theory and practice. The American Counseling Association (ACA) has reinforced cultural competence by including, among others, the following competencies needed for counseling diverse groups on its website (www.counseling.org/knowledge-center/competencies):
ACA Advocacy Competencies (March 2003)
ALGBTIC Competencies for Counseling LGBQIQA (June 2012)
ALGBTIC Competencies for Counseling Transgender Clients (September 2009)
Competencies for Addressing Spiritual and Religious Issues in Counseling (May 2009)
Competencies for Counseling the Multiracial Population (March 2015)
Multicultural and Social Justice Counseling Competencies (July 2015)
Multicultural Career Counseling Competencies (August 2009)
Cultural Humility Along With Cultural Competence
Cultural competency provides a baseline for developing awareness, skills, and knowledge necessary for counseling diverse clients. However, without moving toward or embodying cultural humility in relationships, counselors run the risk of becoming overconfident in knowledge and inadvertently relating to clients in rigid, monolithic ways. Cultural humility is “the ability to maintain an interpersonal stance that is other-oriented (or open to the other) with an aspect of cultural identity that is most important to the client” (Hook et al., 2017, p. 354). Having cultural humility means the counselor engages in a continuous process of learning in and out of session. Multicultural orientations require counselors and therapists to commit to a continuous process of developing cultural competency and cultural humility and then implementing these efforts into practice (Gundel et al., 2020). In addition to competence and humility, acting from a culturally responsive place must also be intentional. Simply put, without intentional effort of action and interaction, the other training falls short. As a counselor, this means actions on various levels, such as the personal, interpersonal, community, institutional, public policy, and international/global levels (Singh, Appling, & Trepal, 2020). It also relates to the counselors’ responsibility to change their way of working within the field of counseling, for example, in the counseling clinic, in the university, in ethical standards, in accreditation by the Council for Accreditation of Counseling and Related Educational Programs, and in counselor education.
Multicultural orientations within action reinforce that counselors must not use therapies and therapeutic interventions that are culturally inappropriate but rather use therapies that are affective, affirming, and not harmful. Use of the skill sets, assessment instruments, diagnostic criteria, and approaches to case conceptualization connected with the way counselors work with clients in the United States, for example, would need to be modified. Theories as well as their use need to be modified or adapted. Traditional healing practices can and should be integrated into work with the client even if not delivered by the counselor. For this reason, we include a section on integrating multicultural orientations with theory and discuss therapies that align with multicultural and social justice theories. Importantly, theories not covered in detail here, such as critical race theory, intersectionality theory, and liberation theory, are not counseling theories in and of themselves but are important theories for counselors and counselor educators to inform culturally competent and responsive practice (Singh, Appling, & Trepal, 2020).
Culturally Responsive Therapeutic Integrations
Although many theories support integration of a variety of therapeutic interventions that can be adapted for cultural considerations, there are interventions that are built on values that reinforce the need for cultural responsiveness. The focus is not entirely on the specific therapy approaches but rather on what affords these approaches the ability to address intersectionality within the therapeutic relationship and that embrace the integration.
The Multicultural Orientation Framework
The multicultural orientation (MCO) framework was developed to help counselors with their therapeutic process from a multicultural orientation. Particularly, the MCO framework was developed for integration with existing therapy approaches with an emphasis on the counselor’s cultural humility as a “way of being” rather than as a series of steps or processes (Davis et al., 2018, p. 90). Traditional theories were developed with dominant White, Western, male, industrialized, heteronormative, and English-language perspectives. “Social justice theories can help contextualize these traditional counseling theories and models” (Singh, Nassar, et al., 2020, p. 248). At the same time, there are limitations because many theories, even when adapted, have underlying paradigms, such as individualism, that are difficult, if not impossible, to remove.
The MCO framework rests on three pillars: cultural humility, cultural comfort, and cultural opportunity (Davis et al., 2018). Along with cultural humility as described earlier, cultural comfort relates to how a counselor is “at ease, open, calm, or relaxed with diverse others” (Davis et al., 2018, p. 92). Cultural opportunity means that counselors respond to the cultural sharing and expressions of a client with curiosity, engagement, and a sense of affirmation and that they ask about the client’s cultural beliefs, values, and ways as opportunity. In addition to contextualizing traditional theoretical orientations from a social justice perspective, counselors can also bring an ease about culture and cultural difference to the sessions, can explore culture with curiosity, and do so as an other-oriented way of being in regard to the social location and lived experience of clients.
A Relational Attunement Approach
Brainspotting psychotherapy and other somatic experiencing therapies (e.g., eye movement desensitization and reprocessing, somatic experiencing) are examples of approaches that are not inherently associated with social justice and multicultural orientation. However, they are more culturally responsive because they emphasize relational attunement, recognition, and affirmation of somatically held trauma and rely on phenomenological perspectives that focus on observation (Grand, 2013). This approach demands that counselors bring awareness to the interplay of power, privilege, and oppression that are present within the counseling relationship (Brinkman & Donohue, 2020). Approaches to therapy that embrace the unknown and uncertainty can create more room for cultural humility and strength of the therapeutic relationship (Grand, 2013). Brainspotting psychotherapy relies on the uncertainty principle, whereby the counselor is attuned to the client’s own unique process (Grand, 2013). As such, a dual attunement frame is another essential part of therapy