Use of Culture-Centered Counseling Theory with Ethnically Diverse LGBT Clients

Abstract

The intersection of ethnocultural and sexual orientation identities presents unique challenges that mandate cultural competence in assessing and intervening with ethnically diverse lesbian, gay, bisexual, and transgender people. Effective counseling with this population requires an understanding of non-Eurocentric, nonheterosexual worldviews as well as an awareness of the sociopolitical realities of lesbian, gay, bisexual, and transgender life. Culture-centered counseling theory provides an effective framework for addressing the needs of ethnically diverse lesbian, gay, bisexual, and transgender clients. A review of the literature on counseling ethnically diverse lesbian, gay, bisexual, and transgender people is provided along with case illustrations to illuminate the use of culture-centered counseling theory with this population. Recommendations focus on counselor training to increase ethnocultural knowledge and clinical competence and to reduce personal bias.

KEYWORDS:

• intersectionality
• identity
• LGBT
• lesbian
• gay
• bisexual
• transgender
• culture-centered counseling
• multicultural counseling

Culturally diverse lesbian, gay, bisexual, and transgender (LGBT) clients have limited involvement in the mental health service delivery system and are frequently underserved (Adams, Cahill, & Ackerlind, 2005; Kocarek & Pelling, 2003). This is particularly true for members of ethnocultural groups such as African Americans, Latino Americans, Native Americans, and Asian Americans in the United States, who have been historically marginalized due to institutionalized racism and other forms of oppression (Chan, 1995; Fukuyama & Ferguson 2000; Garrett & Barret, 2003). Poor conceptualization and misdiagnosis of these clients has led to ineffective treatment and poor outcomes (Gitterman, 2001; Stone, 2003).

Most problematic in addressing these concerns is that clinicians often frame ethnically diverse LGBT clients within a Eurocentric, heterosexual paradigm that fails to incorporate their ethnocultural worldview or their sociopolitical realities (Fukuyama & Ferguson, 2000; Tully, 2001). Sociopolitical (socially constructed norms and prevailing opinions) realities and conditions contextualize attitudes of acceptance and inclusion toward socially marginalized individuals by mental health professionals and laypeople alike (Sue & Sue, 2008). As such, ethnically diverse LGBT clients often experience alienation from counselors and other mental health providers when they are most in need of support and assistance (Gitterman, 2001; Stone, 2003).

Despite the profession's emphasis on multicultural competence over the past three decades, counselors continue to evidence difficulty in effectively conceptualizing and intervening with clients who experience multiple forms of systemic oppression, such as racism, classism, homophobia, and sexism (Arredondo, Tovar-Blank, & Parham, 2008). The concept of intersectionality addresses the nuanced complexities of multiple identities that cannot be sufficiently captured using conventional identity development models, such as racial (Helms, 1995; Sue & Sue, 2008) and gay/lesbian (Cass, 1979; Minton & McDonald, 1984).

While scholars continue to advance knowledge about the clinical needs of ethnically diverse LGBT clients, much of what has been written has been theoretical in nature. Counselors can better benefit from real world cases, based on the experiences of practicing counselors, highlighting the use of culture-centered interventions designed to meet the needs of the intersected identities of ethnically diverse clients. Culture-centered counseling theory (Pedersen, 1991; Pedersen & Ivy, 1993) emphasizes social-cultural conditions by examining contextual factors that influence client empowerment and self-awareness. Additionally, this theoretical framework uses the clients’ own value-based conceptualization of psychological wellness to situate the therapeutic process. Thus, culture-centered counseling offers a more effective approach for intervening with this population because it addresses the unique needs, experiences, and worldviews of ethnically diverse LGBT individuals.

The purpose of this paper is to present an overview of the clinical issues presented by ethnically diverse LGBT clients and to provide information on culture-centered counseling as a more effective framework for assessing, conceptualizing, and treating this population. This paper provides a review of the literature on working with ethnically diverse, LGBT clients along with a presentation of case illustrations utilizing culture-centered interventions with this population. Additionally, the authors offer recommendations for counselor training and clinical research.

REVIEW OF THE LITERATURE

Often referred to as the hidden minority (Nichols, 1999), LGBT individuals continue to be marginalized in society. Hence, they may encounter myriad mental health concerns, such as affective disorders, chronic stress, eating disorders, substance abuse, and suicidal ideation (Israel & Selvidge, 2003; Savin-Williams, 2001). Moreover, hostility and victimization in schools (Parks, 2001; Stone, 2003), heterosexism in the workplace (Lyons, Brenner, & Fassinger, 2005), and discrimination by conventional religious organizations (Barret & Barzan, 1996) cause additional concern. Members of these marginalized groups are often forced to develop ways of negotiating their identities that exist outside the mainstream (Fukuyama & Ferguson, 2000). For example, they may keep their sexual orientation hidden and pretend to be heterosexual. LGBT individuals may also avoid discussion of romantic relationships or use opposite sex gender pronouns when referring to romantic interests or partners. Perhaps the most challenging aspect of their development is managing the shame that is often associated with an LGBT identity. For ethnically diverse LGBT individuals, this process is further complicated by the task of race-based marginalization and discrimination.

Intersectionality of Identity

Identity development models have been significant in the conceptualization of certain developmental tasks that individuals may encounter (Cass, 1979; Cross, 1995; Helms, 1995; Minton & McDonald, 1984; Phinney, 1992; Troiden, 1979). In general, these models describe stages that individuals move through in developing positive identities, such as ethnic, gender, or sexual orientation identities. However, critics of these models assert that growth is neither linear nor bound by well-defined categories (Martinez & Sullivan, 1998). They further suggest that these models overlook the intersection of identity that is experienced by ethnically diverse LGBT people (Greene, 2001; Whitney, 2006).

Specifically, racial and ethnic identity development models do not acknowledge the role that sexual orientation plays in identity formation (Martinez & Sullivan, 1998). Gay and lesbian identity development models, in particular, neglect the influence of culture and racism in the evolving gay identity and recognize only positive gay identity after coming out (acknowledgement of sexual orientation to significant others) (Martinez & Sullivan, 1998; Whitney, 2006). Fukuyama and Ferguson (2000) assert that when counselors exclusively recognize a client's single identity, such as ethnic or class identity, they render clients invisible within specific social reference groups. As such, theories that do not acknowledge multiple identities obscure the complexity of identity integration.

Managing multiple identities is a task that is faced by various culturally diverse LGBT clients, including those of various ethnic groups (Chan, 1995; Fukuyama & Ferguson, 2000; Garrett & Barret, 2003), women (Brown, 1995), the elderly (Reid, 1995), and those persons with different abilities (Whitney, 2006). Members of these groups are often forced to develop ways of negotiating their identities that exist outside of the mainstream. The intersection of multiple identities is complex; salience of identity often shifts depending on an individual's current social environment and stage of psychosocial development (Greene, 2001). Identity development of ethnically diverse LGBT individuals is further complicated by (a) their internalization of mainstreamed pejorative views of LGBT concerns that inhibit their expression of identity and (b) prevailing and systemic heterosexist attitudes in society that create ecosystemic obstacles to identity integration (Frable, 1997; Greene, 2001).

Culture-Centered Counseling Theory

In a call to the counseling profession, Sue, Arredondo, and McDavis (1992) articulated multicultural counseling competencies that address counselor attitudes, knowledge, and skills. These standards were later revised and distinguished multiculturalism (narrowly defined as ethnicity, race, and culture) from diversity (more broadly defined as age, class, gender, sexual orientation, and physical ability differences) (Arredondo et al., 1996). Other scholars however, argued for inclusion of lesbians and gay men into the understanding of multicultural counseling based on their status as a cultural minority with its own economic and social organizations, cultural traditions, and rituals (Pope, 1995).

Scholars have also asserted that the needs of LGBT clients warrant special attention (Israel & Selvidge, 2003; Kocarek & Pelling, 2003; Pope, 1995). Concerns that are unique to the LGBT population include being raised in families that do not share their history of marginalization, having a minority status that is hidden and necessitates coming out to others over a lifetime, and facing ongoing questions about the etiology and malleability of their sexual identity (Israel & Selvidge, 2003). As such, LGBT clients may need additional support resources, role models and mentors to aid in the coming out process, and coping skills that support their authentic self-expression.

Clients’ adherence to their own cultural orientations shapes their view of presenting problems and influences the types of coping strategies employed. As such, counseling interventions informed by cultural values and adapted to an individual's worldview and coping strategies can be more effective (Pedersen & Ivey, 1993). For example, in the African American community, intergenerational family units provide collective economic, social, and emotional resources that have historically aided them in coping with systemic oppression and frame their perspective of current difficulties (Nobles, 1997; Sudarkasa, 1997). This is in contrast to Eurocentric values that emphasize individualism in human interactions and development (Kambon, 1996; Sue & Sue, 2008).

Theorists assert that cultural orientations differ between dominant and nondominant individuals (Atkinson, 2004; Holdstock, 2000; Ibrahim, Roysircar-Sodowsky, & Omishi, 2001). For example, affect, communalism, and spirituality are generally valued in African American culture, a strong sense of interdependence is evident in many Latino families and an expected obedience to parents and parents’ demand for conformity is commonplace in Asian culture. For many Native Americans, an emphasis on the concept of the circle classifies the world into categories ranging from appropriate to inappropriate rather than right and wrong. Within a Eurocentric cultural value system that places emphasis on individualism, effort optimism, and competition, such contrasting values are often overlooked, understated, or devalued (Garrett & Barrett, 2003; Greene, 1997; Jagers, Smith, Mock, & Dill, 1997).

Described as the fourth force in counseling (Pedersen, 1991), culture-centered counseling calls for a unified approach to multicultural counseling that is balanced with culture-specific strategies. Several models emerged from this paradigm shift and focused primarily on counseling racially and ethnically diverse individuals. Multicultural counseling theory (MCT) (Pedersen & Ivey, 1993) and various ethnic-centered counseling theories (Fuertes & Gretchen, 2001) highlight various ways to conceptualize and facilitate multicultural counseling. Focusing on the sociopolitical and environmental context of the client's concerns, these models emphasize exploration of multicultural constructs.

Culture-Centered Counseling Theory and LGBT Clients

Ethnically diverse LGBT clients are often marginalized by racism in mainstream LGBT culture as well as by heterosexism and homophobia in their ethnic communities, leaving them at risk for isolation, estrangement, and increased psychological vulnerability. Internalization of oppression can result in identity confusion and self-hatred (Martinez & Sullivan, 1998). As a result, ethnically diverse LGBT people may present in counseling with any number of mental health concerns (Garofalo, Cameron, Kessell, Palfrey, & DuRant, 1998).

Culture-centered theory provides a framework for the accurate conceptualization of presenting issues with ethnically diverse clients that is critical to successful outcomes (West-Olatunji, 2008). A culture-centered approach requires client-centrality wherein counselors avoid imposing their own reality by conceptualizing presenting issues from the client's worldview. Additionally, culture-centered theory considers ecosystemic factors in conceptualization and treatment (Pedersen & Ivey, 1993) thus enabling counselors to better understand the impact that family dynamics, religion, racism, and heterosexism have on their clients’ mental health. Working within a culture-centered paradigm also incorporates an understanding of sociocultural conditions that includes issues of oppression and discrimination, historical experiences (e.g., acculturation, immigration), and social positioning in the workforce, education, and the media. With a minimal knowledge of social-cultural influences, counselors can better conceptualize the needs of ethnically diverse individuals (Pedersen & Ivey, 1993; West-Olatunji, 2008).

Culture-centered theory also calls for facilitation of critical consciousness (Goodman & West-Olatunji, in press) whereby clients understand their social positioning as well as the sociopolitical context of their concerns (Ivey, 2003; Lewis, Lewis, Daniels, & D’Andrea, 2003; Nelson & Neufeldt, 1998). Critical consciousness involves the ability to move from reflection (on one's personal empowerment in relation to systemic oppression and marginalization), to dialogue (in order to co-construct new knowledge or solutions), to action (by confronting existing obstacles that serve as barriers to growth and development; Freire, 2000). The following case illustrations reflect issues faced by ethnically diverse LGBT individuals and illuminates the use of culture-centered counseling interventions when working with this population.

CASE ILLUSTRATIONS

Case 1: David

David is a 20-year-old man who identifies as Native American and gay. He sought counseling because he has mixed feelings about his sexual identity. He believes that he is gay, but according to his conservative Christian beliefs, being gay is wrong. In addition, he desires to embrace more of his Native American heritage but is not sure how to incorporate those beliefs into his value system. His goals for counseling are to address his sexual identity conflict while maintaining his spirituality and find ways to connect with his Native American heritage.

The counselor used a culture-centered framework to understand David's presenting concerns from the perspective of his value system. While he identifies as Native American, his value system is rooted in Eurocentric, conservative Christian culture. Several generations of David's family including his parents, also embrace a similar cultural identity. They maintained a connection to their Native American heritage through the oral tradition, stories passed down from previous generations. However, David states that gays and lesbians were not represented in those stories. Despite the connection to their heritage, David's family believed that their mainstream conservative values were more important because they enabled them to fit in, which made life easier. David identified with the desire to fit in but, his sexual identity as well as his desire to “be more Native American” made him feel like an outsider.

Using the Racial/Cultural Identity Development Model (Sue & Sue, 2008), the counselor conceptualized David of being at the beginning stage of racial/cultural identity development, the conformity stage where one primarily relates to the dominant culture. In honoring David's desire to connect to his Native American heritage, the counselor explored ecosystemic factors that support the disconnect between his heritage and his current conservative Christian identity. The foundation for this disconnect was created by the historic loss of Native American culture through decades of federal Indian policies designed to assimilate them into the White American mainstream (Kelly & Nagel, 2002) and by Christian missionaries who introduced them to different worldviews and value systems (Garrett & Barrett, 2003). Additionally, his family's desire to fit in perpetuated the belief that the mainstream values were superior to those of his native culture.

David developed a greater understanding of the sociopolitical history of Native American culture. To further support the development of critical consciousness, the counselor introduced him to information about the Two-Spirit, a term used to describe LGBT people who were once honored among Native Americans for embodying both masculine and feminine spirits (Adams & Phillips, 2006; Garrett & Barret, 2003; Tafoya, 2003). Although David's pride in his heritage grew, he struggled with shame about his sexuality as well as the practical implications of embracing a positive gay identity in a social environment that is hostile to LGBT people. He was especially concerned with how his family would react to the knowledge that he is gay.

David embraced the traditional Native American values of cooperation and harmony and therefore did not want to upset the balance in his family at that time by revealing his sexual identity. He believed that the welfare of his family took precedence over his individual suffering. Thus, coming out to them was not emphasized as a sign of his progress in counseling. He did agree with the counselor to continue assessing his decision about coming out to his family as he believed that it could change over time.

As a supplement to the individual counseling, the counselor recommended readings that assisted David in addressing the shame about his sexuality and with understanding the intersection of gay identity and spirituality. The counselor also helped him expand his support network to include community-based groups and online resources in order to increase his exposure to others who are confronting similar issues and build community among like-minded people. As David continued to work on integrating his identities, he embraced the concept of the circle (Garret & Barrett, 2003), a Native American belief that what would normally be seen as opposites, such gay identity and spirituality or Native American values and Christian values, are thought of as existing in a circle with no real beginning or ending.

Case 2: Erica

Erica, a 25-year-old who identifies as both Latina and lesbian, sought counseling because she felt torn between her commitment to her partner and her commitment to her family. She described her family as a traditional Latino family and stated that despite their religious (Catholic) beliefs, they have been supportive of her since she came out as lesbian. She states that while they are kind to her partner, Melanie, they often speak of her as Erica's good friend instead of her partner.

Melanie, who is White, believes Erica's family is disrespectful and pressures Erica to demand that her family address them as partners instead of friends. Erica believes that her family's kindness toward her partner is a sign of their acceptance of their relationship even though it is not explicitly stated. She states that she understands Melanie's point of view, while at the same time she appreciates her family's process of coming to terms with her sexual identity.

Erica states that commitment to family and especially respect for her parents is a critical aspect of her cultural identity. She admits, however, that she has experienced a “clash of cultures” on other occasions between her traditional Latina values and those of her diverse peer group. For example, she recalls being resentful toward her parents when she was younger because her brothers were always given more freedom than she was afforded. She also believed that her parents’ requirement that she attend religious services on a regular basis negatively affected her social life. However, she enjoyed the closeness among her family members including her extended family and close family friends who were “just like family.” Her goal for counseling was to find balance between her commitment to her family and commitment to her partner.

The counselor understood the presenting problem from Erica's perspective of being a “clash of cultures.” Using the Racial/Cultural Identity Development Model (Sue & Sue, 2008) as a framework, the counselor conceptualized Erica to be in the Introspection Stage of racial/cultural identity development that is characterized by the ethnically diverse individual moving away from strict adherence to their cultural norms and exercising greater personal autonomy.

The counselor also understood the ecosystemic factors that influenced Erica's identity development. Discussion of her exposure to mainstream values such as individualism versus family interdependence emphasized in Latina culture (Bridges, Selvidge, Matthews, 2003), as well as her religious upbringing and the differences in sex role expectations in her family, helped Erica understand her current dilemma.

Counseling interventions were designed to assist Erica in coming to terms with her identity. They involved clarifying her attitudes and beliefs about (a) herself, (b) others in her cultural group, (c) members of other ethnically diverse and marginalized groups and, (d) members of the dominant cultural group (Sue & Sue, 2008). She also identified values that she embraced from each of these groups in order to shape her individual cultural identity.

Development of critical consciousness involved the counselor supporting Erica's self-empowerment and confidence in her blended cultural identity. She also developed strategies for coping with the sociopolitical realities of living as a Latina who is lesbian with a diverse value system. Erica began to refer to Melanie as her partner in the presence of her family while refraining from asking that they adopt similar language. She reports that her relationship with Melanie improved as they developed an appreciation for their cultural similarities and differences.

Case 3: Andrew

Andrew is a 30-year-old, single, African American gay man who reported feeling isolated and lonely. He reports that some members of the African American community, including members of his family, have marginalized him because of his gay identity. He further states that his involvement in the predominantly White, gay community has not been satisfying due to difference in cultural identities and interests. He sought connection in gay-affirming churches since many of the traditional African American Christian churches that he was familiar with view homosexuality as sinful. However, he experienced a similar cultural disconnect as those churches lacked the verve and spontaneity that he appreciated in traditional African American churches. Andrew's role models of openly gay African Americans are national political and cultural figures who are not accessible to him. He reported being confident in his identity but was concerned about not fitting in with the two communities he identifies with most.

The counselor understood Andrew's desire for connection with the African American and gay communities. His experience of marginalization by his family, the African American community including Christian churches as well as the disconnect with the predominantly White gay community were among the ecosystemic factors that influenced his experience of isolation and loneliness.

Andrew reported that many of his African American gay friends had abandoned either their spirituality or their sexual orientation identities due to the discrimination they experienced. However, he remained committed to expressing a positive gay identity while embracing traditional African American values of spirituality, empowerment, and community. Considering Andrew's presentation through the lens of the Racial/Cultural Identity Development Model (Sue & Sue, 2008), the counselor assessed him at being in the Integrative Awareness Stage of racial/cultural identity development. Although he is experiencing marginalization resulting in loneliness, he is secure in his identity and maintains a high sense of autonomy.

Andrew empowered himself through the development of critical consciousness. Discussions of his social positioning within the African American and gay communities helped to reinforce his understanding of the sociopolitical influence on his experiences of marginalization and discrimination.

Finally, building on Andrew's desire for community, the counselor helped him develop strategies to expand his support network. He developed greater confidence as a leader and began to host small social gatherings and discussion groups at his home. He became close to a few members of the group, adopting them as family exemplifying the notion of fictive kinship (Chatters, Taylor, & Joyakody, 1994) that is common in the African American community. He had not found a church that met his needs; however, he read inspirational material and practiced meditation on a regular basis in order to facilitate his spiritual development.

DISCUSSION

Use of culture-centered counseling theory with ethnically diverse LGBT clients provides an alternative framework for conceptualizing their needs and facilitating appropriate intervention (see Table 1). Often facing many forms of oppression, these clients are challenged by the task of negotiating multiple identities (Salazar & Abrams, 2005). These clients may be further victimized by culturally encapsulated counselors’ acts of microaggression, albeit unintentional (Sue, 2007). In Andrew's case, the counselor demonstrated a culturally appropriate response to his dilemma of coping with multiple identities. Through discussions of his social positioning within the African American and gay communities, the counselor helped him understand the sociopolitical influence on his experience of marginalization. Furthermore, the counselor supported him in embracing values that were salient to both his African American and gay identities.

Conceptualizing LGBT clients’ concerns in the appropriate cultural context is critical for successful outcomes (Wynn & West-Olatunji, 2008). For example, ethnically diverse LGBT clients’ presenting concerns may be more related to ecosystemic issues than to intrapersonal dilemmas (Israel & Selvidge, 2003). While it is vital to asses the extent to which homophobia has affected an LGBT client's life, counselors must also realize that being LGBT may not be relevant to the presenting problem (Tully, 2001). For instance, in Erica's case, it might appear that her primary problem was not having pride in her sexual identity particularly in the presence of her family. However, her actual concern was about the cultural conflict in her relationship and blending her traditional Latina values with elements of mainstream culture.

Recommendations

In order to create a safe, therapeutic environment, it is critical that counselors are aware of their own attitudes and biases toward ethnically diverse LGBT individuals. By expanding their personal boundaries to include interaction with ethnically diverse LGBT people, counselors can explore their attitudes and beliefs by engaging in professional development activities. In a race-based society, most counselors have had very few opportunities to further their awareness of race-based and cultural privilege. Many counselors are like fish in water in that their cultural mores are the normative values in society (Sue & Sue, 2008). Thus, without awareness training, it becomes difficult to see or appreciate nonmainstream behaviors, attitudes, or worldviews. With increased knowledge of ethnoculturally different worldviews as well as the associated ecosystemic factors that affect their clients, counselors are able to conceptualize and treat ethnically diverse LGBT clients.

Professional development activities that have been shown to be successful in advancing counselors’ cultural competence have been immersion programs, such as the Association of Multicultural Counseling and Development and Association for Counselor Education and Supervision (AMCD/ACES) international outreach programs in southern Africa (Davis & West-Olatunji, 2008). These joint endeavors have proven effective in helping counselors to reflect on their socialized biases and privilege in relation to their efficacy as practitioners, particularly when working with culturally different clients. Immersion experiences provide participants with firsthand knowledge of differences through continued exposure and contact with community members. Continuous contact with diverse groups of people also provides counselors with an opportunity to learn about ways in which communities have historically solved their problems. For instance, in many cultures, healing occurs through song, music, dance, vibrations, and silence rather than use of talk therapy. Immersion experiences can be valuable learning opportunities, even for seasoned professionals.

Counselors should also be skilled at facilitation of critical consciousness so that clients become aware of their social positioning and the sociopolitical context of their concerns. These interventions are critical for increasing agency and, ultimately, resilience. Leaders in counseling have called for the integration of social justice and advocacy into counselor identity (Ivey, 2003; Lewis et al., 2003). Moreover, there is a need to expand the understanding social justice in multicultural competence (West-Olatunji, in press). A key component of emotional and psychological health is the ability to advocate on one's own behalf and that of other marginalized individuals.

In order for counselors to become facilitators of critical consciousness for their clients, it is important that they also develop the ability to reflect, dialogue, and act in relation to their own lived experiences (Freire, 2000). Reflection can take the form of journaling, meditation, or prayer. The important element is taking time to think and to think deeply without the daily clutter of activity and busyness. Dialogue provides counselors with the opportunity to engage in synergistic conversation and discussion with others to gain knowledge that is co-constructive from the group experience thus benefiting from the collective lived experiences and funds of knowledge from the dialogic collaborators (Goodman & West-Olatunji, 2009). This can occur in a variety of types of groups, such as story circle, book reading, supervision, or online discussion thread/blog. Action, or praxis, involves transformative doing. Transformation occurs when an individual takes a different path and has different outcomes. This is just as important for the counselor as it is for the client.

Future Research

Use of a culture-centered theoretical framework to explore the intersectionality of identities among ethnically diverse LGBT individuals is warranted (Roysircar, Arredondo, Fuertes, Ponterotto, & Toporek, 2003; Tillman, 2002). While scholars have theorized about the use of culture-centered theory in practice, little has been done to explore the use of this theory in research design. Use of qualitative methodology can illuminate the concerns of ethnically diverse LGBT individuals and may identify possible risk factors that make them vulnerable as well as the protective factors that support their resilience. Such inductive investigations might advance knowledge about the relationship between use of culture-centered counseling theory, intersectionality of identity, and LGBT client populations. Outcomes of such studies might enhance counselors’ understanding, conceptualization, and treatment of ethnically diverse LGBT clients. Utilizing a culture-centered methodological framework in research design and implementation as well as in data interpretations (Tillman, 2002; West-Olatunji, 2005) might reduce the influence of cultural bias in research inquiry that contributes to the systemic oppression of marginalized groups.

Table 1 Culture-Centered Interventions

	Illustrations Used
Culture-Centered
Theory	Case #1: David	Case #2: Erica	Case #3: Andrew
Aspect 1	The counselor understood	The counselor understood	The counselor understood Andrew's
Client-centrality (conceptualize presenting issues using client's value system)	David's desire to integrate his identities and to connect with his Native American heritage.	Erica's concern about the “cultural clash” that was affecting her relationships and individual identity.	desire for connection with the African-American and gay communities despite his experiences of marginalization and discrimination.
Aspect 2	The counselor identified the	The counselor facilitated	The counselor considered Andrew's
Ecosystemic factors (consider sociocultural conditions)	historic loss of Native American culture, David's sexual identity, his religious beliefs, and his parents’ desire to “fit in” as contributing factors to his values conflict.	discussion of the affects of religion, sex role expectations, and cultural value differences on Erica's identity development.	experience of marginalization by his family, the African-American community including Christian churches as well as the disconnect with the predominantly White gay community in the initial case conceptualization.
Aspect 3	The counselor introduced David	The counselor supported	The counselor facilitated discussions
Critical consciousness (develop healthy identity and understand social positioning and sociopolitical aspects of presenting problems)	to information on the Two Spirit that supported his empowerment and integration of identities. David developed a greater understanding of the sociopolitical history of Native American culture.	Erica's empowerment and assisted her in developing coping strategies for living with a blended cultural identity.	on Andrew's social positioning within both the African-American and gay communities that helped him understand the sociopolitical influence on his experience of marginalization and discrimination.

In summary, culture-centered counseling theory can provide an effective framework for addressing the needs of ethnically diverse LGBT clients. Counselors need to increase their knowledge of non-Eurocentric, nonheterosexual worldviews through professional development opportunities that better prepare them to work with this population. Future research in this area might include the use of culture-centered counseling theory to investigate the intersectionality of identity of ethnically diverse LGBT clients.