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Book Forum: Psychotherapy   |    
Counseling the Culturally Diverse: Theory and Practice, 4th ed.
Am J Psychiatry 2004;161:1137-a-1138. doi:10.1176/appi.ajp.161.6.1137-a
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Columbia, Mo.

By Derald Wing Sue and David Sue. New York, John Wiley & Sons, 2003, 507 pp., $80.95.

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This hefty tome looks, feels, and reads like a textbook for graduate students in counseling psychology. Obviously, since this is its fourth incarnation, it has been very successful, and it is generally accepted as the best book in the field. The keys to its success are simple: it is comprehensive, clearly written, neatly divided into 20 chapters ending with sections on implications for clinical practice, and contains many clinical vignettes that balance the theoretical material.

The book starts slowly, with a discussion of the "superordinate nature" of multicultural counseling, the politics of counseling and therapy, and sociopolitical considerations of trust and mistrust. Much of this section can be summed up by the authors’ contention that

the power of racism, sexism, and homophobia is related to the invisibility of the powerful forces that control and dictate our lives. In a strange sort of way, we are all victims. Minority groups are victims of oppression. Majority group members are victims who are unwittingly socialized into the role of oppressor. (p. 72)

Despite this ominous start, the book moves on to clinical material that really is quite practical. The authors argue correctly that a counselor/therapist dealing with culturally diverse clients needs to be adaptive and not tied down to traditional approaches, although I couldn’t help but chuckle at the suggestion that change-agent outreach programs may involve shooting basketball and playing billiards with clients. Thank God we psychiatrists have patients who, unlike clients, would most likely swoon or run away at the suggestion that we shoot a few hoops together. Just imagine the possibilities of such a scenario in the hands of the comedian Larry David in a episode of Curb Your Enthusiasm! But I digress.

The section of the book that most fascinated me was on white racial identity development. Here the authors explore the responses of different people to the question, "What does it mean to be white?" In fact, I plan to spend an entire session of my cultural psychiatry seminar asking the residents to answer this question. The authors note that

whiteness is transparent precisely because of its everyday occurrence and because Whites are taught to think of their lives as morally neutral, average, and ideal.…Persons of color find White culture quite visible because even though it is nurturing to White Euro-Americans, it may invalidate the lifestyles of multicultural populations. (p. 239)

As a resource book for teaching about clinical competence, the book is terrific. Ideally, all psychiatrists should be familiar with the book’s contents, but I seriously doubt that, after a mind-numbing day of 15-minute medication management visits, there are many psychiatrists who have the will and strength to read this lengthy tome. More’s the pity, because through years of personal experiences I have learned that our pills tend to be more efficacious and our patients more compliant when we pay attention to cultural facts. If you go about things the right way, it’s amazing sometimes what can be accomplished in 15 minutes.




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