Guidelines on Cultural Response/ability in Training, Research, Practice, Supervision, Advocacy & Organizational Change

Ratified by the NADTA Board: June 18, 2015
Version 1, July 2015

The North American Drama Therapy Association (NADTA) is a non-profit 501c6 organization incorporated in 1979 to establish and uphold high standards of professional competence and ethics among drama therapists; to develop criteria for training and registration; to sponsor publications and conferences; and to promote the profession of drama therapy through information and advocacy. The Association serves professionals and students in the United States and Canada, and the organization includes members throughout the world.

NADTA Cultural Humility, Equity and Diversity Committee (CHEDC)

CHEDC is charged with the promotion of cultural competency in drama therapy training and practice within the membership of the NADTA. CHEDC promotes dialogue around diversity and social justice in all aspects of the organization and profession of drama therapy.

This document is the result of the NADTA’s longstanding commitment to championing the diversity and dignity of its members and of those who receive services from drama therapists. These guidelines were drafted by Nisha Sajnani, Jessica Bleuer, Patrick Tomczyk, and Jami Osborne in consultation with CHEDC and participants of the 2014 NADTA Diversity Forum: Christine Mayor, Christina Opolko, Andrew Gaines, Diana Elizabeth Jordan, Britton Williams, Saphira Linden, Deborah French Frisher, Truc Nguyen, Stephanie Bayne, Adam Davis, and Antoinetta Dellicarpini. This document was also circulated to to NADTA members who had the opportunity to provide valuable feedback as well as Dr. Ditty Dokter, Mandy Carr, and Sarah Bilodeau of the British Association of Dramatherapists’ Equality and Diversity Sub-Committee.

The following documents were also consulted:

• Association for Multicultural Counseling and Development: Multicultural Competencies (1996)
• American Psychological Association:  Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists- American Psychological Association (2002)
• American Art Therapy Association Multicultural Competencies (2011)
• Canadian Association for Music Therapy: Code of Ethics (1999)
• The Counselors for Social Justice: Code of Ethics (2010)

PREAMBLE

Article 5a of the NADTA Code of Ethics (hereafter referred to as the Code) states that, “A drama therapist does not engage in unfair discrimination based on, but not limited to, age, gender, identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, socioeconomic status, physical appearance or attributes, or any basis proscribed by law.”  

As drama therapists, we are sensitive to the power and influence of stories, roles, and repeating patterns in our lives and in the lives of those with whom we work. These guidelines are intended to encourage drama therapists to remain responsive to the presence and impact of implicit and explicit bias in the contexts in which we practice towards avoiding ‘unfair discrimination’ and to encourage us to contribute to cultivating relationships and environments in which all people are treated with dignity.

The concept of cultural response/ability refers to responsive and responsible training, research, practice, supervision, advocacy and organizational change in drama therapy (Sajnani, 2012). Cultural response/ability, in this context, is supported by two other concepts. The first is cultural competency which comprises awareness, knowledge, and measurable skills that increase the ability to notice and challenge implicit biases as well as serve diverse individuals and groups (Arredondo et.al, 1996). The second concept is cultural humility which refers to “a lifelong process of self-reflection, self-critique, continual assessment of power imbalances, and the development of mutually respectful relationships and partnerships” (Tervalon & Murray-Garcia as cited in Gallardo, 2014). Cultural humility espouses a process-oriented approach to competency as it is “the ability to maintain an interpersonal stance that is other-oriented (or open to the other) in relation to aspects of cultural identity that are most important to the [person]” (Hook, Davis, Owen, & Utsey, 2013, p. 2).

Note, these guidelines do not constitute a change to the NADTA Code of Ethics. Rather, this document is intended to be used as a supplement to the Code.

DEFINITIONS

Culture is defined as the fluid and dynamic embodiment of a worldview through learned and transmitted beliefs, values, norms, and social institutions including psychological processes (e.g care-taking, expressions of distress, notions of well-being etc.) (Fiske, Kitayama, Markus, & Nisbett, 1998). Inherent in this definition is the acknowledgement that all individuals are cultural beings and have a cultural heritage that is informed by their socialization and affiliation with multiple, intersecting, and dynamic social groups (e.g., family, nation, religious group, professional community, etc.).

Cultural identity is based on membership in multiple groups that continuously interact and influence each other. Identity within these groups is adapted and changed throughout life in response to political, economic, educational, and social experiences that either alter or reinforce one’s position in society. It is also affected by interactions with the dominant group and power relations among groups in society. Membership in some cultural groups (group of drama therapists, group with similar in/visible disability, group with similar job description, spiritual or gender-based group, etc.) may take on more importance than others at different periods of life (Johnson, Musial, Hall, & Gollnick, 2005).

Cultural competency comprises awareness, knowledge, and measurable skills that increase the ability to notice and challenge implicit biases as well as serve diverse individuals and groups (Arredondo et al., 1996).

Cultural humility refers to “a lifelong process of self-reflection, self-critique, continual assessment of power imbalances, and the development of mutually respectful relationships and partnerships” (Tervalon & Murray-Garcia as cited in Gallardo, 2014). Cultural humility espouses a process-oriented approach to competency as it is “the ability to maintain an interpersonal stance that is other-oriented (or open to the other) in relation to aspects of cultural identity that are most important to the [person]” (Hook, Davis, Owen, & Utsey, 2013, p. 2).

Guidelines

Guideline One: Commitment to Cultural Awareness and Knowledge of Self and Others

Drama therapists are encouraged to recognize that, as cultural beings, we each hold attitudes, beliefs, and biases that can influence our perceptions of and interactions with individuals who are different from ourselves. Therefore, drama therapists are encouraged to actively reflect on how our own cultural backgrounds influence our attitudes and values and bias how we interpret behavior such as help-seeking, expressions of distress, touch, role-play, etc.

Drama therapists actively seek out knowledge and understanding about how cultural oppression (e.g. racism, homophobia, transphobia, poverty, sexism, religious intolerance, ableism, sizeism, ageism etc.) affects them personally and in their work. This involves an assessment of how one has been impacted by and/or directly or indirectly benefiting from interpersonal, institutional, and cultural forms of bias.

Guideline Two: Commitment to Cultural Response/ability in Drama Therapy Practice

Drama therapists demonstrate commitment to the treatment of all persons with dignity and respect, regardless of differences in age, ethnicity, geographic region, gender identity, gender expression, military status, physical, mental, or developmental capacity, nationality, political views, race, religion, socioeconomic status, sexual orientation, and historical experiences with the dominant culture.

Drama therapists are encouraged to avoid practices that constitute cultural appropriation. Cultural appropriation involves a dominant group’s use of the signs and symbols of people who have been systematically oppressed for personal gain in status or otherwise. This differs from a cultural exchange which is the mutual or permitted sharing of symbols and practices between groups.

Drama therapists are encouraged to actively reflect on and inquire about on their own and their clients’ sources of comfort and discomfort with cultural differences and commonalities that exist between themselves and clients with respect to age, ethnicity, geographic region, gender identity, gender expression, military status, physical, mental, or developmental capacity, nationality, political views, race, religion, socioeconomic status, sexual orientation, and historical experiences with the dominant culture.

Drama therapists are encouraged to demonstrate their respect for the clients' indigenous, religious and/or spiritual beliefs and values, including attributions, taboos, symbolic traditions, and preferred methods of treatment because they may affect worldview, psychosocial functioning, expressions of distress, and perspectives on touch, role-play and other drama therapy activities (Code: Article 7).

Drama therapists take responsibility for including their clients in an inquiry about the rights and responsibilities as partners in an embodied therapeutic process. Drama therapists are prepared to make explicit the cultural context, power dynamics, internalized privilege and internalized oppression of both the therapist and the client. Drama therapists recognize that properly executed, the informed consent process is a way of engaging the participation of clients; a means of empowering clients; and a means of providing clients with clear information about the benefits, goals, and limitations of drama therapy treatment and the drama therapist’s philosophical orientation.

Drama therapists are encouraged to consider the potential bias in assessment and evaluation instruments and use procedures and interpret findings keeping in mind the cultural and linguistic characteristics of the clients.

Drama therapists are encouraged to be flexible in the drama therapy approach used to support clients and recognize that helping styles and approaches may be culture bound. Drama therapists also familiarize themselves with the artistic traditions and theater making processes used by their clients. They strive to understand how their clients’ imagery reflects those values, even if they would be seen as pathological, resistant, or stereotypic when viewed through another perspective.

Drama therapists are encouraged to help clients determine whether a problem stems from racism, classism, sexism, ageism, or other forms of social bias so that problems are not inappropriately personalized.

Drama therapists are encouraged to develop knowledge of culturally specific resources (i.e., interpreters/translators) and take responsibility for becoming aware of barriers (i.e., inflexible hours for providing services, transportation) that prevent clients from various groups in accessing and utilizing mental health services.

Drama therapists are encouraged to recognize the value of interacting in the language requested by the client and, if this not feasible, drama therapists should seek an interpreter with cultural knowledge and appropriate professional background or refer to a knowledgeable and competent bilingual drama therapist or related mental health professional.

Drama therapists actively reflect on the limits of their competencies and, where needed, they (a) seek consultation, (b) seek further training or education, (c) refer out to more qualified individuals or resources, or (d) engage in a combination of these (Code: Article 5).

Guideline Three: Commitment to Cultural Response/ability in Drama Therapy Training

Drama therapists are encouraged to seek out educational, consultative, and training experiences including language acquisition to enrich their understanding and effectiveness in working with clients who have historical and cultural backgrounds and experiences that are different from their own.

Drama therapists also take responsibility for educating themselves about relevant identity development models, historical and current discriminatory practices at the societal level (i.e., racism, classism, sexism, ableism, homophobia, sizeism, ageism, transphobia, etc.), and global sociopolitical and intergenerational issues (i.e., wars, occupation, and natural disasters in country of origin) that may be affecting the psychological welfare of clients in care.

Drama therapy educators are encouraged to assess which worldviews are privileged and missing in the context of training and to incorporate these and related guidelines into courses pertaining to ethical and responsible practice.

Drama therapy educators are encouraged to include critical perspectives in every course in order to prepare students to better identify, analyze, and evaluate personal assumptions as well as the social, economic, and political factors that influence the provision of care through drama therapy.

Drama therapy educators are encouraged to refer students to courses/electives and other resources that may aid them in understanding the cultural considerations relevant to clients in their care.

Drama therapy educators are encouraged to practice cultural humility with students in order to remain open to those aspects of cultural identity that are most important to students.

Guideline Four: Commitment to Cultural Response/ability in Drama Therapy Supervision

Drama therapy supervision is understood as a critical component of ethical practice (Code: Article 5). Supervisors of drama therapists are encouraged to actively reflect on and inquire about their own and their supervisees sources of comfort and discomfort with cultural differences and commonalities that exist between themselves and supervisees with respect to age, ethnicity, geographic region, gender identity, gender expression, military status, physical, mental, or developmental capacity, nationality, political views, race, religion, socioeconomic status, sexual orientation, and historical experiences with the dominant culture.

Supervisors are encouraged to refer supervisees to resources that may aid them in understanding the cultural considerations relevant to clients in care.

Supervisors are encouraged to practice cultural humility with supervisees in order to remain open to those aspects of cultural identity that are most important to supervisees and to model how supervisees might engage in similar conversations with clients.

Guideline Five: Commitment to Cultural Response/ability in Drama Therapy Research

In addition to principles concerning informed consent and research protocols defined in the NADTA Code of Ethics (Article 8), drama therapists are encouraged to recognize the significant role that research can play in social change and the value of conducting culturally responsive, developmentally appropriate, and collaborative research especially with those whose voices are seldom included in the creation of policies and practices affecting their lives. Drama therapists are also encouraged to familiarize themselves with relevant research and latest findings regarding the impact of racism, classism, sexism, homophobia, xenophobia, and other forms of oppression on mental health, as well as critical perspectives in drama therapy that are useful when considering persons served.

Guideline Six: Commitment to Cultural Response/ability in Advocacy & Organizational Change

Drama therapists are encouraged to contribute their knowledge and skills to their professional association in order to support the growth of the NADTA as a culturally responsive and responsible organization. Drama therapists are encouraged to support organizational discourse, training, research, and policy development in this and all areas. Drama therapists are also encouraged to involve themselves in acts of solidarity with individuals within their communities on a personal and professional level where appropriate.

REFERENCES

Arredondo, P., Toporek, M. S., Brown, S., Jones, J., Locke, D. C., Sanchez, J. & Stadler, H. (1996) Operationalization of the Multicultural Counseling Competencies. Alexandria, VA: Association for Multicultural Counseling and Development.

Corey, G., Corey, M., & Callanan. (2011). Issues and ethics in the helping professions (8th ed.). Belmont, CA: Brooks/Cole.

Hook, J. N., Davis, D. E., Owen, J., Worthington Jr., E. L., & Utsey, S. O. (2013). Cultural humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology. doi:10.1037/a0032595

Fiske, A., Kitayama, S., Markus, H.R., & Nisbett, R.E. (1998). The cultural matrix of social psychology. In D. Gilbert, S. Fiske, & G. Lindzey, The handbook of social psychology, vol. 2 (4th ed., pp. 915–981). San Francisco, CA: McGraw-Hill.

Johnson, J.A., Musial, D.,  Hall, G., Gollnick, D. (2005). Foundations of American education: Becoming teachers in challenging times (16th ed.), New York, NY: Pearson.

Lee, C. C. (Ed.). (2006). Multicultural issues in counseling: New approaches to diversity (3rd ed.). Alexandria, VA: American Counseling Association

Mayor, C. (2012). Playing with race: A framework and approach for creative arts therapists. The Arts in Psychotherapy, 39 (3), 214-219.

Remley, T. P. & Herlihy, B. (2007) Ethical, legal, and professional issues in counseling (2nd ed.). Upper Saddle River, NJ: Pearson Education, Inc.

Sajnani, N. (2012). Response/ability: Towards a critical race feminist paradigm for the creative arts therapies. The Arts in Psychotherapy, 39 (3), 186–191.