A treatment model for the psychological sequelae of discrimination is illustrated via three treatment cases in which experiences of racism and gender, ethnic, or religious hostility were a primary focus of intervention. The client’s level of psychological functioning, acuity of hate victimization, and coping and identity re-formation strategies are addressed in this phase-oriented model of counseling. The five treatment phases are (1) event containment and safety, (2) assessment of client-event characteristics, (3) addressing diversity in the counseling alliance, (4) acute symptom reduction, and (5) identity recovery and re-formation. Counseling tasks with clients of hate victimization include the amelioration of acute postevent symptoms, reframing of aversive out-group attitudes, alleviating disturbance of in-group identity, and the eradication of avoidant intergroup behaviors. It is proposed that the effective treatment of victims of chronic harassment and acute hate incidents requires the integration of behavioral, cognitive, and multicultural counseling modalities.
Get full access to this article
View all access options for this article.
References
1.
Allport, G. H. (1954). The nature of prejudice. Reading, MA: Addison-Wesley.
2.
American Psychiatric Association (1994). Diagnostic and statistical manual of mental and nervous disorders (4th ed.). Washington, DC: Author.
3.
Atkinson, D. R. , Morten, G., & Sue, D. W. (1993). Counseling American minorities: A cross-cultural perspective (3rd ed.). Dubuque, IA: William C. Brown.
4.
Barlow, D. H. , & Cerny, J. A. (1988). Psychological treatment of panic. New York: Guilford.
5.
Bell, C. C. (1980). Racism: A symptom of the narcissistic personality disorder. Journal of the National Medical Association, 72(7), 661-665.
6.
Berk, R. , Boyd, E. A., & Hammer, K. M. (1992). Thinking more clearly about hate-motivated crimes. In G. Herek and K. T. Berrill (Eds.), Hate crimes: Confronting violence against lesbians and gay men. Newbury Park, CA: Sage.
7.
Bower, G. , & Bower, S. (1980). Asserting yourself: A practical guide for positive change. Reading, MA: Addison-Wesley.
8.
Brantley, T. (1983). Racism and its impact on psychotherapy. American Journal of Psychiatry, 140(12), 1605-1608.
9.
Butcher, J. N. , Graham, J. R., & Ben-Porath, Y. (1995). Methodological problems and issues in MMPI, MMPI-2, and MMPI-A research. Psychological Assessment, 7(3), 320-329.
10.
Carlson, E. B. & Rosser-Hogan, R. (1994). Cross-cultural response to trauma: A study of traumatic experiences and posttraumatic symptoms in Cambodian refugees. Journal of traumatic stress, 7(1), 43-58.
11.
Carter, R. T. (1995). The influence of race and racial identity in psychotherapy. New York: John Wiley.
12.
Cascardi, M. , O’Leary, K. D., Lawrence, E. E., & Schlee, K. A. (1995). Characteristics of women physically abused by their spouses and who seek treatment regarding marital conflict. Journal of Counseling Psychology, 63(4), 616-623.
13.
Cass, V. C. (1979). Homosexual identity formation: A theoretical model. Journal of Homosexuality, 9, 105-126.
14.
Cervantes, N. (1995). Hate unleashed: Los Angeles in the aftermath of proposition 187. Los Angeles: Coalition for Humane Immigrant Rights of Los Angeles.
15.
Coleman, H. L. K. (1995, August). Conflict in multicultural counseling relationships: Source and resolution. Paper presented at the 103rd Annual Convention of the American Psychological Association, New York.
16.
Comas-Diaz, L. , & Jacobsen, F. M. (1991). Ethnocultural transference and countertransference in the therapeutic dyad. American Journal of Orthopsychiatrity, 61(3), 392-402.
17.
Comas-Diaz, L. , & Padilla, A. (1990). Countertransference in working with victims of political repression. American Journal of Orthopsychiatry, 60(1), 125-134.
18.
Davidson, J. T. , & Foa, E. B. (1991). Diagnostic issues in posttraumatic stress disorder: Considerations for DSM-IV. Journal of Abnormal Psychology, 100(3), 346-355.
19.
Dunbar, E. W. , & Liu, J. F. (1996). Measuring the impact of intergroup bias: Relating Events of Prejudice to post-trauma sequelae. Unpublished manuscript.
20.
Dunbar, E. W. , Liu, J. F., & Horvath, A. M. (1995). Coping with culture-based conflict: Implications for counseling research and practice. Cultural Diversity and Mental Health, 1(2), 139-148.
21.
Dunbar, E. W. , & Sue, S. (1996). Practitioner impressions regarding race and ethnic material in psychotherapy: Implications for research and practice. Unpublished manuscript.
22.
Dunbar, E. W. , Sue, S., & Liu, J. (1994, August). Experiencing and coping with social group conflict. Paper presented at the 102nd Annual Convention of the American Psychological Association, Los Angeles.
23.
Dutton, M. A. , Burghardt, K. J., Perrin, S. G., Chrestman, K. R., & Halle, P. M. (1994). Battered women’s cognitive schemata. Journal of Traumatic Stress, 7, 237-255.
24.
Fairbank J. A. , & Brown, T. A. (1987). Current behavioral approaches to the treatment of posttraumatic stress disorder. The Behavior Therapist, 10, 308-311.
25.
First, M. B. , Spitzer, R. L., Gibbon, M., Williams, J. B. W., Davies, M., Borus, J., Howes, M. J., Kane, J., Pope, H. G., Jr., & Rounsaville, B. (1995). The structured clinical interview for DSM-III-R personality disorders (SCID-II). Part II: Multi-site test-retest reliability study. Journal of Personality Disorders, 9(2), 192-104.
26.
Foa, E. B. , Riggs, D. S., & Gershuny, B. S. (1995). Arousal, numbing, and intrusion: Symptom structure of PTSD following assault. American Journal of Psychiatry, 152(1), 116-120.
27.
Greenberg, L. , & Safran, J. (1989). Emotion in psychotherapy. American Psychologist, 44, 19-29.
28.
Hathaway, S. R. , & McKinley, J. C. (1983). Manual for the administration of the Minnesota Multiphasic Personality Inventory. Minneapolis, MN: National Computer Systems.
29.
Helms, J. E. (1989). Considering some methodological issues in racial identity counseling research. The Counseling Psychologist, 17(2), 227-252.
30.
Helms, J. E. (1990). Toward a model of White racial identity development. In J. E. Helms (Ed.), Black and White racial identity attitudes: Theory, research and practice (pp. 49-66). Westport, CT: Greenwood.
31.
Herek, G. M. , Gillis, R. J., & Cogan, J. C. (in press). Psychological correlates of hate crime victimization among lesbian, gay, and bisexual adults: The Sacramento hate crimes study.
32.
Horowitz, M. J. , Wilner, N., & Alvarez, W. (1979). Impact of event scale: A measure of subjective distress. Psychosomatic Medicine, 41, 209-218.
33.
Johnson, S. D. (1987). Knowing that versus knowing how: Toward achieving expertise through multicultural training for counseling. The Counseling Psychologist, 15(2), 320-331.
34.
Johnson, W. B. (1995). Narcissistic personality as a mediating variable in manifestations of post-traumatic stress disorder. Military Medicine, 160(1), 40-41.
35.
Karon, B. (1995). Becoming a first-rate professional psychologist despite graduate education. Professional Psychology: Research and Practice, 26(2), 211-217.
36.
Kazdin, A. E. (1992). Methodological issues and strategies in clinical research. Washington DC: American Psychological Association.
37.
Kazdin, A. E. , & Kagan, J. (1994). Models of dysfunction in developmental psychology. Clinical Psychology: Science and Practice, 1, 35-52.
38.
Kim-Goh, M. , Suh, C., Blake, D. D., & Hiley-Young, B. (1995). Psychological impact of the Los Angeles riots on Korean-American victims: Implications for treatment. American Journal of Orthopsychiatry, 65, 138-146.
39.
Klonnoff, E. A. , & Landrine, H. (1995). The schedule of sexist events: A measure of lifetime and recent sexist discrimination in women’s lives. Psychology of Women Quarterly, 19(4), 439-473.
40.
Kriegrer, N (1990). Racial and gender discrimination: Risk factors for high blood pressure?Social Science Medicine, 30, 1273-1281.
41.
Levin, J. , & McDevitt, J. (1993). Hate crimes: The rising tide of bigotry and bloodshed. New York: Plenum.
42.
Liebmann, M. (1996). Arts approaches to conflict. Bristol, U.K.: Kingsley Publishers.
43.
Linehan, M. (1993). Dialectic behavior therapy with borderline personality disorders. New York: Guilford.
44.
Liu, J. F. (1995). Examining ethnic and gender differences in coping with culture-based conflict. Paper presented at the 103rd Annual Convention of the American Psychological Association, New York.
45.
Liu, J. F. , & Dunbar, E. (1994). In J. Fong (Ed.), The experience of social group conflict for Asian-Pacifics: Relating conflict type and cultural identification to coping response. Proceedings of the 1994 Annual Convention of the Asian-American Psychological Association.
46.
Lonie, I. (1993). Borderline disorder and post-traumatic stress disorder: An equivalence?Australian and New Zealand Journal of Psychiatry, 27, 233-245.
47.
Los Angeles County Human Relations Commission . (1994). Annual report of hate crime statistics. Los Angeles: County of Los Angeles.
48.
Mahrer, A. R. (1982). Obtaining instances of the target of the investigation. In A. E. Kazdin (Ed.), Methodological issues and strategies in clinical research (pp. 63-85). Washington, DC: American Psychological Association.
49.
Meehl, P. E. (1977). Specific etiology and other forms of strong influence. The Journal of Medicine and Philosophy, 2, 33-53.
50.
Meichenbaum, D. (1977). Cognitive-behavior modification: An integrative approach. New York: Plenum.
51.
Nagayama Hall, G. C. , Bansal, A., & Lopez, I. R. (1999). Ethnicity and psychopathology: A meta-analytic review of 31 years comparative MMPI/MMPI-2 research. Psychological Assessment, 11(2), 186-197.
52.
Newhill, C. E. (1990). The role of culture in the development of paranoid symptomatology. American Journal of Orthopsychiatry, 60, 176-185.
53.
Ofri, I. , Solomon, Z., & Dasberg, H. (1995). Attitudes of therapists toward Holocaust survivors. Journal of Traumatic Stress, 8, 229-242.
54.
Parad, H. J. (1965). Crisis intervention: Selected readings. New York: Family Service Association.
55.
Resick, P. A. , & & Schnicke, M. A. (1993). Cognitive processing therapy for rape victims: A treatment manual. Newbury Park, CA: Sage.
56.
Ridley, C. (1984). Clinical treatment of the nondisclosing Black client. American Psychologist, 39, 1234-1244.
57.
Root, M. P. P. (1992). Reconstructing the impact of trauma on personality. In L. Brown & M. Ballou (Eds.), Personality and psychopathology: Feminist reappraisals (pp. 229-265). New York: Guilford.
58.
Root, M. P. P. (1994, August). Understanding insidious racism as a relevant context in diagnosis and treatment. Paper presented at the 102nd Annual Convention of the American Psychological Association, Los Angeles.
59.
Ryan, C. , & Bradford, J. (1993). The national lesbian health care survey: An overview. In L. D. Gar-nets and D. C. Kimmel (Eds.), Psychological perspectives on lesbian and gay male experiences (pp. 541-556). New York: Columbia University Press.
60.
Sales, E. , Baum, M., & Shore, B. (1984). Victim readjustment following assault. Journal of Social Issues, 40(1), 117-136.
61.
Scott, M. J. , & Stradling, S. G. (1992). Counseling for post-traumatic stress disorder. London: Sage.
62.
Shannon, B. E. (1973). The impact of racism on personality development. Social Casework, 54(9), 519-525.
63.
Shrier, D. K. (1990). Sexual harassment and discrimination. Impact on physical and mental health. New England Journal of Medicine, 87, 105-107.
64.
Straker, G. , & Mossa, F. (1994). Interacting with trauma survivors in contexts of continuing trauma. Journal of Traumatic Stress, 7, 457-465.
65.
Sue, D. W. (1998). Multicultural counseling competencies: Individual and organizational development. Thousand Oaks, CA: Sage.
66.
Sue, D. W. , & Sue, D. (Eds.) (1991). Counseling the culturally different client (2nd ed.). New York: John Wiley.
67.
Sue, S. , & Okazaki, S. (1995). Methodological issues in assessment research with ethnic minorities. Psychological Assessment, 7(3), 367-375.
68.
Sue, S. , & Zane, N. (1987). The role of culture and cultural techniques in psychotherapy: A critique and reformulation. American Psychologist, 42(1), 37-45.
69.
Suinn, R. M. (1977). Manual—anxiety management training (AMT). Fort Collins, CO: Rocky Mountain Behavioral Sciences Institute.
70.
Trevino, J. G. (1996). Worldview and change in cross-cultural counseling. The Counseling Psychologist, 24(2), 198-215.
71.
Troiden, R. R. (1993). The formation of homosexual identities. In L. D. Garnets & D. C. Kimmel (Eds.), Psychological perspectives on lesbian and gay male experiences (pp. 191-217). New York: Columbia University Press.
72.
Ullman, S. E. (1995). Adult trauma survivors and post-traumatic stress sequelae: An analysis of reexperiencing, avoidance, and arousal. Journal of Traumatic Stress, 8(1), 179-188.
73.
Williams, R. , & Williams, V. (1993). Anger kills. New York: HarperCollins.
74.
Wyatt, G. E. (1994, August). Impact of racism on psychological functioning. Paper presented at the 102nd Annual Convention of the American Psychological Association, Los Angeles.
