cultural competency is a set of congruent behaviors, policies, and attitudes coming together among professionals or in an agency or system that enable work to be done effectively in cross-cultural situations. Culture is the integrated pattern of behavior of human beings that includes thoughts, language, actions, communications, beliefs, and values, social and religious groups. Competence is being in a capacity to function in an effective manner as an organization or individual within the context of cultural beliefs, needs, and behaviors which are presented by communities and the consumers.
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Cultural competency is very important because it forms the main ingredient in closing the gap for disparities in health care. It is a way of coming together of doctors and patients where they discuss health concerns having no differences in culture that may hinder conversation but instead enhance it. Health care services that respect and respond to the health beliefs, cultural, practices, and linguistic needs of diverse patients help in bringing positive health outcomes. Language and culture influence healing, wellness, belief system, and health. It also influences the perception of illness or disease and the causes by the patients and how the people who seek health care believe and the attitudes they have towards providers of health care. (Sue, 1990 pp35-36)
The effort to moralizing our efforts to impact disproportionality and disparities in child welfare
Culture grows and matures just the way babies do. Multicultural society has people who belong to cultures that are thousands of years in age and they live together with people who belong to cultures that are few centuries old. Differences in cultural development manifest themselves in different ways.
For example, the independence which is cherished in western culture permeates life aspects which includes how social institutions work, psychotherapy practice, and functioning of the family in dealing with marital relationships, old age, and parenting. Parents encounter great pain in ensuring that their children are able to become independent where they begin by having sleeping arrangements which are separate for the baby.
In Indian culture, dependability is cherished and permeates through social institutions aspect of family life. Parents are proud when they reach their old age and see their children have grown up to be truly dependable beings. In parenting young children, there is an atmosphere of physical closeness; common sleeping arrangements, indulgence and granting those immediate emotional and physical needs and prolonged babyhood which makes growing child feel deeply dependable on the parents, community and extended family.
When children approach latency period, they get help in order to heighten their sensitivity to the feelings of other people and get improved capacity to regulate and contain their feelings. In the cultural context of acting on your own feeling and disregarding the others, it shows emotional immaturity.
Self expression or expressing opinions that heighten and define sense of selfish is not a desirable goal. Self cherishing attitude is always derived from philosophical system that is well formulated and lies at the cultures wisdom. For example, having a sense of self can be a product of mental processes which are illusory and the mental events happened in mind moments within an eye wink. The rapidity of mental processes creates illusion of continuity where there is sense of solidity relationships and feelings. (Dwivedi 1993, 14-16)
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Attachments of self cherish and self grasping is natural and inherent and we talk of things personally, flag with self expression, autonomy, independence, heading towards narcissism and self assertion. This is a natural tendency that is produced by illusory processes and the root cause of our sufferings but illusory processes cannot be cut through easily. To be able to become enlightened or disillusioned, extra effort is necessary to resist the strong flow of current. The efforts in life aspect range from meditative practices up to continued life of extended family and have high value in cultural context. Natural love tendency flows towards ones husband, child or wife.
But, in case of extended family, there are many nuclear families and survives when there is redirection of love across nuclear boundaries. This gives an opportunity for training and practicing for the transcending narcissistic tendencies. In system of extended family, parents offer affection, play materials and food to the children in extended families before they can take care of their own children. They go to an extent of referring to the child of other people as their own and their child as other people’s child and the ideology of love growing in hiding can take away all the pressure for proving or showing ones love.
A scene of family therapy can be pictured by conditioning therapist to look for overt affectionate behaviors as love evidence that exist between family members by conditioning family to express each others deep love through hiding it before the onlookers or imagine parenting situation assessment where professionals and parents have different values which are attached to transitional objects and play materials. There are people who judge feelings of parents to their children according to the names they give their children. Some of the children bully or tease others due to their awkward names making them damage their self esteem. Some children are given names that mean rubbish because they have been precious and they regard them as such for the whole of their lives. (Dwivedi 1993, 17-19)
Influences of mature culture mediate through the practices of rearing a child, inner emotional strength, networks forgiving help and social supportive structures that give protection to mental health problems in families and the children. When children are young, they see their parents as wonderful beings on earth but as they grow up, it dawns upon them that as they think their parents are the best, even other children think that their parents the best.
When they mature, they appreciate and respect their differences in perspective by bowing down and becoming more humble. Living in context that is multicultural and at the middle of different perspectives of culture and levels of concern is enriching and complementary but the experience can be damaging due to intolerance.
There is a triadic relationship where father, mother and the child are in state of balance when the three of them love each other and no pressure for change is from within the system and they support each other. A vacuous balance exist where each of them in the relationship give support to each other and two of them may be negative and the other one positive. For example, child and the mother love each other but hate the father who in turn hates both of them. In a situation of two positive relationships and a negative one, there is a state of imbalance and internal pressure may emerge from the system to make the relationship change.
The wish of the child would be for both parents to change their own attitude and be positive to each other and also pressure may be put by parents in order for the child relationship with the other parent to be negative for the system to be balanced.
This principle is applicable to relationship that exist between parent and professional and some culture aspect. If the parent considers aspect of culture as an essential ingredient to enhance growth and development and it is considered most to proper growth by professional, they can be entrenched in their own attitudes to it. If there is a positive relationship between the parent and the professional, it may not last long due to the state of imbalance.
Both of them may wish that some sense may be seen so that they can change their attitudes but if this is not the case, relationship between one another may turn to be negative for the system to balance. Similarly, relationship between professional, child and culture where professional has negative attitude that is fixed can balance by change of child attitude in negative direction towards the aspect of culture, towards professional or both. If commitment of the child to cultural aspect has not been strong enough, this is likely to be negative. (Dayal, 1990 pp32-33)
Children who belong to ethnic minorities get exposed to stress that affect any child. For example, demanding school work, getting on with members of the family, life events, financial matters, social conflicts and health issues. In addition, children who belong to ethnic minorities experience stress that is related to dislocated family background and related to racism. Night shifts, poor wages, long hours of working, bad housing and overcrowding can increase health problem risks and have an impact on psychological development of children.
Racism leads to direct or indirect discrimination, inequality, abuse and disadvantages regarding housing, education, training opportunities, welfare and abuse and undermining culture, self image and identity. This leaves children and their families having a feeling of hopelessness after an experience of racial abuse and bullying in schools and play grounds. Communities are denigrated by racism that lower self esteem and bring about depression and sense of worthlessness.
British society has cultural imperialism that manifest itself in education, media, books, psycho-therapy literature and social work leading to the subconscious assumption of superiority of child rearing practices in western. Cultures of ethnic minority are described in ways that make them appear backward or seem bizarre. Stress for ethnic minorities is due to extended family background that is disrupted. In culture with emotional support from extended family, it is the best coping strategy if there is stress, dislocation and migration deprives ethnic minority families the healing support. This social culture fragmentation makes them vulnerable to loss of their cultural strength.
Lack of resources to meet needs of mental health of the population has not been of help in developing services for populations of ethnic minority. Poor uptake of service of mental health in a child by families in ethnic minorities due to variety of factors like clash of the cultural values, lack of awareness and faith in services, communication difficulties and sense of alienation. Services may be set up by professionals of mental health which are not culturally sensitive to the ethnic minorities and they are waited to come and professionals wonder why the came. They may appear like minority communities do not have psycho-therapeutic approaches up to when there is western science and have invented in it. There is extensive therapeutic knowledge in many cultures and practices that regards feelings, relationships and mental health. (Dayal, 1990 pp34-36)
In context of loss of social culture that is emotionally supportive of extended family and fragmentation of help giving network, in time of distress youngsters turn to their professionals and peers. However, to be able to elicit emotional support and sympathetic response, youngsters present themselves to peers and professionals in a manner that can elicit it. Self poisoning by Asian girls due to the product of projective identification symbolizes act of dominant group viewing minority as poisonous or harmful.
Therefore, in meeting ethnic minority children needs, it requires people to set work of community outreach, translation services and interpreter and therapeutic family that is culturally sensitive and giving subjugated narratives voice. Professional development needs should incorporate perspective of difference and cultural awareness through diversity by gaining knowledge and cultural sensitivity by use of experiences to challenge respective cultural identities on understanding and accepting others.
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United States has remained the center for ethnic diversity and experience for a long period of time but boom of contemporary immigration through community and school programs such as compelling adjustments where practitioners and educators interact with their students and understand their needs. However, white, English speakers have continued to make majority of teachers and providers of childcare. These circumstances have made practitioners develop authentic understanding about cultural contexts where youth reside and develop to be able to plan their programs depending on protective factors and risks in the background of children.
Cultural competence is important for conceptions of youths by practitioners. Practitioners are culturally competent that risk factors are associated socio-demographic and cultural status but the backgrounds of children are potential assets. For example, the study about drug use among adolescents shows that drug abuse is diminished by having knowledge about ethnic identity and cultural history. (Heider, 1998 10-12)
There are many advantages a youth gets by attending culturally competent programs. Programs with high cultural competence incorporate values and ideas of youths into their structures and activities and the collaboration serves to increase enjoyment of youths to the programs and ensure there is attendance and continued involvement. Youths attend culturally inclusive programs and understand their background and others based on benefits of diversity and positive assets. Practitioners who are culturally competent adopt multicultural elements in programming instead of employment of mono-cultural outlooks that disregard value of diversity. Multicultural education is able to promote psychological development that is healthy for youths in all cultures from childhood to adolescence.
Individuals and programs build cultural competence through perpetual adaptation and self evaluation. Incorporating materials and activities for prompting practitioners and youths to transcend levels of cultural comfort assist individuals in communicating and effective development. Self reflection and time help to determine how cultural background influence interactions with families and youths but some concrete activities can be done by an individual or the program.
Groups can participate in experiment of breaking social norms where individuals choose behavior that is expected in the society and perform legal action against the behavior as individuals report to the group on how they felt. Breaking of the social norms is away of gaining insight on how expectations and behaviors which are culturally based influence interactions and comfort level.
Communication is made difficult by cultural barriers and linguistics and result to lack of interaction and misunderstandings. It is helpful to take first step towards open communication in order to know participants and the families where they belong.
Parents should be e-mailed directly or use handouts in languages that parents can understand to enable them participate and engage in conversations. Adolescents and children should engage in project based education where there are fun activities and youths are encouraged to collaborate on programs of social service that are important and of help to the communities. Participants of the programs are involved in projects that demand cross culture collaboration where they learn team work with different people and still succeed in giving aid to their communities. (Heider, 1998 13-15)
Out of school programs get opportunity for modeling cultural competence and also value multiculturalism and impart important values and skills to the participants. Youth workers are educated on cultural competency as first step in socializing children for them to be open minded and socially conscious members of the community. When cultural competence is enhanced, it does not necessarily overarch shift in program structure or activities because many time the programs which are out of school cultural competence through various methods. For example, there is a series of story quilting where quilt squares are created by parents to represent their backgrounds and offer diverse group of children and parents chances to take action through collaboration and ensure there is change in the communities and school. (Sue, 1990 pp33-34)
Effort to moralizing our efforts to impact disproportionality and disparities in the work place
The United States latest report on census shows that in every three Americans, one of them belongs to ethic/racial minority group. The deep ethnic texture challenges pathologists of speech language and audiologists for them to have knowledge about cultural diversity and its impact on the professions. Respecting cultural diversity is important for a workplace to be successful and forms foundation in the building of intercultural competence. Culture says that good enough is a way of believing, perceiving, behaving and evaluating which is shared. An individual can not know all the cultures but getting understanding of critical features differentiating them helps clinicians to get essential tool for treatment.
Individualism versus culture
This is where there is great value put on individuals and the decisions they make that consist and individualistic culture. If great value is put on the group and its membership, then the culture is collectivist. According to collectivist culture, membership of the group goes beyond nuclear family to reach extended family with decisions made and actions serving as support to the group. Individualists lay emphasis on individual accomplishment while collectivists emphasize harmony and teamwork.
Individualists always speak for themselves but collective can speak for individual. When people with individualistic culture receive therapeutic or diagnostic services, they decide about course of treatment with input from immediate family members but family members have direct influence on decisions about course of treatment for people from collectivist cultures.
In the work place, personal recognition and accomplishment is valued by individualists and they get comfort from relationships with equal status and feel at ease when working alone and have little importance on age and gender. Collectivists are reluctant and enjoy working in teams and take long time before they develop personal relationships. They are comfortable with titles and authority and recognize how vertical relationship is important.
A view of space and time
Culture is distinguished through the way it adheres to schedule. Individuals who have clock time culture are able to organize all their days, plan well and give more emphasis to punctuality. Culture for American, Hispanic and Indian are event oriented where instead of adhering to schedules strongly, they ensure they complete one event even if it takes long before they can begin another. Issues may arise when event oriented culture clients are not adhering to schedules and have vague response to questions which are asked concerning temporal events.
Roles played by men and women
There are different roles played by both men and women which vary across cultures and have influence on ownership, choice of profession and have influence on accessing education. Many cultures are involved in men making decisions for women. Individuals from countries in middle eastern have gender roles that may affect whether woman receives treatment in absence of male family member. Roles of gender affect the extent to which body of a woman is exposed during clinical examination.
Class and status
In the groups of Euro-American, social class is defined by job prestige, level of education and income. Status is the place of respect of a person in a society. Americans are egalitarian and hierarchies exist in other cultures and individuals of high status and class expect privileges. Asians who are comfortable with hierarchies, status differences and value professional achievements would prefer professionals to display degrees and use their titles. However, a Native American client get impressed by having professional degrees or interested more in qualities of personal clinicians and relationship they have with their clan. (Ahmed, 1986 pp13-14)
The values shared by people of culture are understood well from the cultures view of relationship that exists between man and nature and human beings with other human being and degree of materialism. In giving treatment to a Hispanic client, sense of concept requires clinicians to show that there is a paramount relationship where treatment of people who are in authority shows there is respect and personal interest instead of impersonal interest in the relationship.
Communication comes as a product of non-verbal acts and verbal code. Clinicians know how semantics, syntax, pragmatics and phonology language aspect have influence on interpersonal communication. Communication is affected by degrees of context being crucial when deriving meaning. Communication is different among cultures in information that is implied by context or setting. Culture is different on continuum that range from low to high context.
In cultures of high context, contributions of context by adding words themselves are significant in communicating the meaning. In cultures of low context, words are very crucial where every statement is precise. When interacting with people from cultures of high-context, culturally competent clinicians become cognizant of nonverbal communication exchange aspects such as gestures, eye contact, and use of silence, space and touch.
Ceremonies or rituals are ways which are accepted in commemorating the meaningful life changes, historical events and renewed commitment to the shared values. Rituals are rooted in the religion and many rituals are always associated with births, wedding, and religious worship. Clinicians are aware of events, ceremonies, cerebrations and festivities that are observed by client and might coincide with sessions that are scheduled.
According to the importance of work, Americans are defined by the work they do. When a young lady becomes engaged, we are interested to know about the husband to be and the work he does. In many cultures, people are defined by groups where they belong and the role played in the community. The impact as a result of loss of work due to trauma or disease is related to how clients view work and this is considered by clients when delineating goals of treatment, selecting stimuli and activities which are functional for clients who belong to different cultures.
Cultures are different in explaining disabilities and Native Americans view disabled individuals as special or being images of people who are holy or bewitched. In certain people of native America, is a person suffers stroke, he is considered to be hit by wind and illness occur in many cultures once individual gets out of harmony with the universe or nature. There are cultural differences that occur when the person is trying to determine the person who is appropriate for restoring well being and providing health care.
Spiritualists, herbalists, witch doctors and folk healers are chosen over the western medical professionals. In addition to values that are macro cultural in binding people together, individual belong to micro cultures that are defined by education, geographical region and age. Clinicians are supposed to be familiar with micro-cultures and the impact they have on cross-cultural interactions. If we are given migration patterns of our nation, clinicians are supposed to explore the level of clients and the change process that is associated with using rules and learning another culture.
Very few people are born having cultural competence and many more people put considerable effort to develop it. Prejudices and biases are examined in looking for role models and development of cross-cultural skills and spending time with people with passion for the cultural competence. The definition of cultural competence has been shared by diversity professionals from healthcare industry with useful perspective in diversity of work.
Cultural competency is policies, attitudes or congruent behavior and policies in an agency or system where professionals or agency are able to work effectively in situations of cross-culture. Organization is required to have set of values that are defined and demonstrate attitudes, structures and policies to be able to work effectively. There should be skills which are knowledge based for providing patients with effective clinical care from racial or ethnic group. Development process is supposed to evolve over extended period where organizations and individuals are at levels of awareness along continuum of cultural competence. (Ahmed, 1986 pp15-17)
Health care professionals were the first in promoting cultural competence but there was poor diagnosis because there lacked cultural understanding. For example, there were fatal consequences in delivery of medical service. in the business community, individual career and self esteem can be destroyed by cultural incompetence but psychological impact that is unobservable on victims go unnoticed unless there is threat of suit of class action that bring them to the light. Skills and knowledge are needed to have interaction with people from different cultures but others have focus on attitudes.
People should have awareness by being conscious of their personal reactions to different people and skills, knowledge and awareness add component of attitude in emphasizing differences between increasing awareness through training and participants examining carefully the values and beliefs about cultural differences. Research in social science indicates that our beliefs and values on equality are inconsistent with behaviors which we may not be aware of.
Whether we have attitude to cultural differences that match our behavior, there is benefit through improving cross-cultural effectiveness and common diversity goal is creating inclusive system to enable members work at maximum levels of productivity. Skills help in perfecting cultural competence and communication is fundamental in ensuring people in organizations interact because it includes non-verbal communication and gestures that are different from one culture to another.
In the work place, conflicts arise as a result of disagreement between involved parties where they perceive threat to their concerns, interest and needs. In the disagreement, there is difference in positions of involved parties who are in conflict but perceived disagreement versus true agreement are different from each other. In fact, significant misunderstanding levels accompany conflicts and exaggerate perceived disagreement. If there is understanding of true disagreement areas, we would be able to solve problems and manage our needs.
The involved parties in conflict in our sense are in disparities and people get surprised after learning that they are party to conflict and we get shocked when we are not included in disagreement. Many times people who work as a team or company influence each other to participate in disputes whether they like it or not. People take sides depending on current perceptions of relationships, past issues and role they play in the organization. (Paniagua, 1994 pp23-25)
When threat is perceived, people respond to it rather than true threat. Thus perception is not reality and feelings, ongoing responses and people’s behavior are modified by evolving threat that is confronted. If we work to be able to understand true threat and get strategies for managing it we can manage the conflict in a constructive manner. Problem can be defined as a task, substance or near-term viability. However, conflicts in workplace are more complex and involve relationship that is ongoing with complex and emotional components. There are psychological and procedural needs that are addressed in a conflict and presentation of substantive needs. Durability of concerns and parties interests transcends immediate presenting situation.
Conflict occurs if people perceive it to be a consequence of disagreement and they have threat to concerns, needs and interests. In organization life, conflict is normal and offer growth opportunities through improved insight and understanding.
Conflict can be viewed as negative experience that is caused by difficult situations which are abnormal. Finite resources available and limited options are perceived by disputants in seeking solutions instead of multiple possibilities existing outside the box where we are problem solving. In a conflict, threat is perceived by people as a physical, status or power threat to their own well-being and participants respond on how they perceive the situation rather than reviewing it objectively.
Perceptions and reactions of people are filtered through culture, value, beliefs and experience. Responses t conflicts are filled with feelings and ideas that are powerful and strong guides to getting possible solutions.
Conflicts have procedural, psychological and substantive dimensions that are negotiated to be able to have good understanding of perceived threat by the people involved in conflict. Within work place, conflicts are experiences that are normal and expectable and predictable situations that arise naturally as we manage stressful and complex projects which are invested significantly. As such, procedures used to identify conflicts are identified and systems for managing conflicts constructively and new opportunities are discovered for transforming conflict into learning experience that is productive.
Healthy and normal organizations experience conflict and work place can dysfunction. Conflict anticipation helps to transform situations into growth and learning opportunities. For example, there are seasonal work load peak annually and as such challenges occur, they should be managed as normal period of transition and stress. Staff meting help to solve problems effectively in various situations that includes anticipated conflict but staff regard these channels as non-productive, closed and unsafe and are replaced by back-biting and gossip. conflicts are understood through examining results of behaviors which are categorized according to styles of conflicts with each style meeting the needs in times of disputes but have different impact on other people. (Paniagua, 1994 pp26-27)
Competing is a style that advocates for ones own needs above needs of other people and relies on aggressive communication style having low regard for exercising coercive power and future relationship. Competitive style seek to control a discussion in ground rules and substance and fear loss of control might bring about solutions that do not meet their needs resulting in responses to increase threat. Accommodating is used by a person to yield his needs and being diplomatic by allowing group needs overwhelm their own needs that are not stated and what is seen a important is to preserve relationship.
Avoiding act as a common response where conflict is perceived negatively and if it is not brought up, it can blow over but this happens if views are not expressed and conflict continues up to the point where it can not be ignored.
Compromising allows people to give and gain series of tradeoffs but it is not satisfying. Our individual perceptions shape us and we lack trust avoid risk involved in collaborative behaviors. When collaborating, individual goals and needs are pooled together to achieve a common goal where problem solving involves win-win and assertive cooperation and communication to get better solution that individuals could be able t achieve it alone. Chance of consensus is offered and integration of needs and exceeding possibilities of budget that limits our views of conflict by bringing new ideas, energy and times to have a meaningful way of resolving disputes. (Beardsley, 1999 pp11-12)
In conflicting situations, we experience anger, confusion and fear to despair. There is misunderstanding of emotional responses because people believe they have similar feeling with others making them have confusing and threatening responses. Cognitive responses are thoughts and ideas we have about conflict and act as internal observers or inner voices. Men and women have different perceptions of situations based on their experience and patterns of socialization that show the importance of relationship. This makes them approach situations which are conflictive with different mindsets and desired outcomes and existing possible solutions.
People respond to conflict based on their knowledge on issue at hand which includes knowledge of specific situations and the experience they have. This is of great influence on the willingness of a person to engage in conflict management by reinforcing the confidence for dealing with dilemma and undermining how a person is willing to consider alternatives in a flexible manner. (Beardsley, 1999 pp13-14)
In France, textile producing regions studied moral and physical conditions of working class in France where there is a mixture of all ages and sexes where he argued that, the most principle abuse was women being employed alongside men, excessive working hours and pay advances and loans that was used to bind workers to the employers. More attention was on ensuring that sexes are mixed in workplace instead of solving any other problem and ensuring there is equality in industrialized system. Capitalism, gender order, patriarchy and class order inflated in the minds of people.
The patriarchal family was portrayed as bedrock of society that was properly ordered and its breakdown in working class was a sign of social decay to many observers. Employers viewed gender role as center of debate and workers caused social question that need to be resolved. Workers had shared assumptions of social superiors about proper role of both men and women where common assumptions were used to get conclusions that were radically different.
Industrialization brought about economic upheavals due to unprecedented levels of mobilization and popular protests that brought about anxiety in people who got fortune from the industry. Different socialism developed and frequent unsuccessful cycles of class insurrection was witnessed by rapid rise in socialist party. Industrial dynasties had discontented and diverse working population that was shaken by class violence and waves of revolution in stabilizing social hierarchies and returning to quiescence and deference of industrial life. (Goldstein, 2000 pp24-26)
Health care is taken to be cultural construct that come about due to belief about nature of a disease in the human body. In delivering health services, issues about culture are very central in the treatment and preventive measures. When cultural differences are understood, valued and incorporated and health related values are incorporated, health care system is able to support and respond appropriately to populations’ unique needs where there is a different culture from the prevailing one.
Cultural competency should help people to understand and interact effectively even if they belong to different cultures because they become aware of their cultural worldview, attitudes towards the cultural differences, cross-cultural skills and the knowledge they have of worldviews and different cultural practices. Development of cultural competence helps in having ability to communicate with, effectively interact and ability to understand people across cultures. (Sue, 1990 pp37-38)
Paniagua A. (1994): assessing and treating culturally diverse clients: thousand oaks, pp. 23-27.
Beardsley L. (1999): understanding cultural diversity: University of Arizona, pp. 11-14.
Goldstein B. (2000): linguistic and cultural diversity: Singular publishing group, pp. 24-26.
Ahmed S. (1986): Cultural racism in work place: Social work, pp. 13-17.
Dayal N. (1990): Psychotherapy services for minority ethnic communities: Journal of psychotherapy, pp. 32-36.
Dwivedi K. (1993): coping with unhappy children from ethnic minorities: Oxford University press, pp. 14-19.
Heider F. (1998): the Psychology of interpersonal relations: John Wiley, pp. 10-15.
Sue W. (1990): Counseling the culturally different: Arena publishers, pp. 33-38.