Cultural mistrust and the rehabilitation enigma for African Americans.

The accessibility and equity of rehabilitation services offered to African Americans have been identified as priorities in Section 21 of the 1993 amendments to the Rehabilitation Act of 1973. The inclusion of emphases for ethnic minorities in federal rehabilitation legislation is warranted given the disproportionate number of minorities with disabilities in relation to their overall representation in the general population. For example, Walker (1988) reported that although African Americans comprise only 12% of the U.S. population, the comparative incidence of disability (15%) for African Americans is considerably higher than for White Americans (8%). Moreover, Bowe (1992) reported that 24%, or one-quarter, of all severely disabled adults of working-age (16-64) are African American.

Despite the potentially large client pool of African Americans with disabilities, the rate of rehabilitation service provision to African Americans can be two to three times lower than for White Americans within both the public and private sectors (Walker, Akpati, Roberts, Palmer & Newsome, 1986). Similarly, Herbert and Cheatham (1988) reviewed research pertaining to rehabilitation service delivery to African Americans and found that African Americans were less likely to be accepted for services in comparison to White Americans. Furthermore, their review revealed that if accepted, African Americans' cases were more likely to be closed without job placement. Also, if job placement occurred, African Americans generally received lower weekly incomes.

Brewington, Daren, Arella, and Randell (1990) identified three factors which may serve as obstacles to successful vocational rehabilitation for persons with disabilities. These three factors are the client, nature of the rehabilitation program, and society. As described by Brewington et al., client variables may consist of factors such as temperament (motivation), interests, work experience, educational level attained, and skills possessed. Program variables may include availability of resources and quality of staff. Finally, societal factors may include attitudes which are prevalent in society that can affect the success or failure of service delivery. Although the interplay among the three factors is an intricate one, client variables have a profound influence on successful rehabilitation and may help to explain the low representation and poor success of African Americans in rehabilitation.

Atkins (1986) noted that a client enters the rehabilitation process with a specific set of beliefs, attitudes, values, and goals which are determined, to a large extent, by the client's previous life experiences. For example, most African Americans with disabilities are aware of negative stereotypes held by members of the majority society against African Americans. In addition, many African Americans with disabilities have encountered prejudice and racism. These experiences shape their world view, including attitudes toward the rehabilitation process.

One attitude that African Americans with disabilities may bring to the rehabilitation process is cultural mistrust (Atkins, 1988; Grier & Cobbs, 1968; Terrell & Terrell, 1981; Triandis, 1976). According to Terrell and Terrell (1981) cultural mistrust refers to African Americans' mistrust of White Americans and traditional American systems (e.g., government, schools, law enforcement). Atkins (1988) asserted that African American clients may approach the rehabilitation process with mistrust and guarded optimism, and that this mistrust may translate into low expectancy for success. Consequently, cultural mistrust may negatively affect one's perception of rehabilitation; thereby reducing the likelihood that African Americans will seek rehabilitation services for employment and disability adjustment.

The purpose of this article is to examine cultural mistrust as both an impediment to rehabilitation entry and as a barrier to successful rehabilitation completion for African Americans. First, the manifestations of cultural mistrust will be delineated and described. Second, cultural mistrust for African Americans with disabilities in rehabilitation will be examined. Finally, implications for rehabilitation counseling practice and research will be provided.

Cultural Mistrust

The development and exploration of cultural mistrust as a psychological and sociological concept can be attributed to several authors (Brazziel, 1974; Grief & Cobbs, 1968; Kitano, 1974; Pedersen, 1988; Russell, 1971; Rutledge & Gass, 1967; Terrell, Terrell & Golin, 1977; Warren, 1969). However, Terrell and Terrell (1981) defined cultural mistrust succinctly as African Americans' tendency to distrust Whites. Terrell and Terrell proposed that cultural mistrust can exist in the following areas: (1) educational and training settings, (2) work/business settings, (3) interpersonal/social settings, and (4) political and legal systems. According to Terrell and Terrell, African Americans' cultural mistrust and suspicion developed in response to racism and mistreatment by the larger American society. Cultural mistrust is characterized by a lack of trust in other people (i.e., White Americans), suspicion of the motives of others, uncertainty about the sequence of events, a sense of individual powerlessness, and a belief that caution is necessary to avoid trouble (Terrell & Terrell, 1981; Triandis, 1976).

Manifestations of Cultural Mistrust

Several therapeutic manifestations of cultural mistrust have been noted by Nickerson, Helms, and Terrell (1994) and Thompson, Worthington, and Atkinson (1994). For example, cultural mistrust has been associated with the following: (1) low expectations about counseling with White therapists, (2) negative attitudes about seeking help from clinics staffed primarily by Whites, (3) lower numbers of self-disclosures for White counselors compared to African American counselors, and (4) higher levels of premature termination from therapy with White counselors in comparison to African American counselors.

In regard to low expectations for counseling with White Americans, Watkins and Terrell (1988) conducted an analogue study (e.g., involving hypothetical counseling scenarios) and found that highly mistrustful African Americans who were assigned to a White instead of an African American counselor expected the counselor to be less accepting, trustworthy, and expert. These African Americans also expected less in regard to the counseling outcome. In another analogue study, Watkins, Terrell, Miller, and Terrell (1989) found that highly mistrustful African Americans expected the White counselors to be less credible (e.g., expert, reliable and sincere) and less able to help them with problems such as general anxiety, shyness, inferiority feelings, and dating difficulties. The results described above are significant because a client's counseling expectations have been shown to affect the counseling process, its outcome, and the manner in which clients relate to the counselor (Bordin, 1955; Singer, 1970). Therefore, the credibility of the rehabilitation professional as well as the client's belief in the rehabilitation professional's ability to help with various problems seem integral to establishing an effective rehabilitation program.

In terms of attitudes toward seeking help from White counselors, Nickerson, Helms, and Terrell (1994) found that higher levels of cultural mistrust among African Americans were associated with more negative general attitudes about seeking psychological help from White counselors. Higher levels of cultural mistrust were also related to an expectation that the services rendered by White counselors would be less relevant, impactful, and gratifying than services rendered by African American counselors. It is highly probable that African Americans seeking rehabilitation will interact with White rehabilitation counselors; therefore, the relationship between cultural mistrust and attitudes about seeking psychological help from White human service professionals is relevant.

Client self-disclosure is regarded as essential to the development of effective counseling and a healthy therapeutic alliance (Cozby, 1973; Jourard, 1971; Ridley, 1984). However, researchers have suggested that African American clients may be less disclosing with White counselors than with African American counselors (Griffith, 1977; Ridley, 1984; Williams & Kirkland, 1971). For instance, Thompson, Worthington, and Atkinson (1994) found that highly mistrustful African American women self-disclosed the least amount to White counselors, but that African American women with low mistrust disclosed the most to African American counselors. The association between racial dissimilarity and self-disclosure between client and counselor has been attributed to African American clients' mistrust and fear that they will be misunderstood or perceived in a stereotypical manner by White counselors. Thus, self-disclosure as a route to counselor/client intimacy and counseling growth for African American rehabilitation clients will be partly influenced by level of trust for White rehabilitation professionals.

Premature termination of counseling for African Americans has been linked to the ethnic difference between counselor and client. In a highly cited study by Orne and Wender (1968), it was found that African American clients who have been assigned a White counselor are more likely to terminate counseling prematurely than White clients who have been seen by a White counselor. A lack of trust of White human service professionals has been suggested as a reason for the higher dropout rate for African Americans. Terrell and Terrell (1984) found that highly mistrustful African Americans seen by a White therapist had a higher incidence of premature termination from counseling than did highly mistrustful African Americans seen by an African American counselor. Given the high probability that African American clients in rehabilitation will encounter a White counselor, understanding the impact that cultural mistrust may have on their perseverance in the program is crucial.

Cultural Mistrust and African Americans with Disabilities

Although research on cultural mistrust has been conducted primarily with nondisabled African Americans within sociological and psychological contexts, there appears to be direct application to the rehabilitation of African Americans with disabilities. Feist-Price and Ford-Harris (1994) suggested that African American clients with disabilities may have difficulty engaging in introspection for greater self-understanding because the rehabilitation professional reminds them of negative past experiences. The authors asserted, for example, that some African Americans resist the rehabilitation counseling process due to poor image and distrust for Whites in general. Thus, encountering a White rehabilitation professional may provoke or agitate prerehabilitation beliefs that Whites are ungenuine and unbenevolent in their interactions with African Americans.

African Americans with disabilities may employ defense mechanisms to protect themselves from the perceived discomfort and pain of self-disclosing to White rehabilitation professionals during rehabilitation counseling (Feist-Price & Ford-Harris, 1994). Defense behaviors may include denial of having a problem, projecting problems onto others, and belligerence to disrupt and discourage assistance. According to Feist-Price and Ford-Harris (1994), mistrust translates into difficulty on the part of African Americans to relax and openly receive rehabilitation services. Moreover, mistrust may help to explain the low number of African Americans seeking rehabilitation services as well as the high number rejecting the services when offered (Herbert & Cheatham, 1988).

As suggested earlier, the previous life experiences of African Americans may create cultural mistrust of the rehabilitation system and its professionals (Atkins, 1988). Being an American of African descent exposes one to a unique set of life experiences (e.g., police brutality, housing discrimination, credit discrimination). It is these experiences which serve to shape an African American's view of social organizations such as the state/federal rehabilitation system. African Americans' skepticism and mistrust of White Americans often stem from injurious contact with organized systems (e.g., police, banks, realtors); thus, the negative contact may deter African Americans from seeking rehabilitation services. Moreover, even African Americans who do inquire about services may do so with low success expectancy levels, particularly if their prior experiences with majority American institutions have been tainted by racial prejudice.

In relation to the interplay between cultural mistrust and expectancy of rehabilitation success for African Americans, the principle of behaviorism (i.e., reinforcement as a motivation for learning and behavior) becomes relevant. Rotter (1954) defined expectancy as "The probability held by an individual that a particular reinforcement will occur as a function of a specific behavior on his part in a particular situation" (107). Similarly, Weiner (1980) postulated that intensity and persistence of behavior are mediated by both expectancies of success and anticipated emotional responses to these outcomes. Given the theoretical assertions of Rotter and Weiner, African Americans with disabilities are likely to enter a rehabilitation process with profound distrust and low expectancies for success because of prior experiences of exclusion and absent reinforcement. In addition, African American clients are likely to exert little effort in working with rehabilitation professionals, especially if prior experiences cause the client to sense negative consequences from interaction with the rehabilitation system.

Implications for Rehabilitation Counseling Practice

Given the complexity of cultural mistrust, rehabilitation professionals must be able to use a variety of techniques when working with highly mistrustful African American clients. According to Ridley (1984), verbal therapy alone may not be a useful technique for African American clients high in cultural mistrust. However, Ridley noted that multimodal behavior therapy (Lazarus, 1989) provides an effective and comprehensive framework for working with these clients. A multimodal orientation employs an array of techniques that comprise seven modalities: (1) behavior, (2) affect, (3) sensation, (4) imagery, (5) cognition, (6) interpersonal relationships, and (7) drags (Lazarus, 1989). Although each of the seven modalities is important, the behavior, affect, imagery, and cognitive modalities appear to be particularly relevant for highly mistrustful African American clients. The common problems and recommended treatments associated with these modalities are presented in order to help rehabilitation professionals effectively serve African Americans with issues of cultural mistrust.

Prior to the use of multimodal techniques to counter cultural mistrust, rehabilitation professionals must first confirm their perceptions of cultural mistrust in African Americans exhibiting characteristics of cultural mistrust. For example, an African American may indicate to a White rehabilitation professional "I can't tell you that because you may use it against me" or ask "Are there any Black counselors working here." Confirmation of cultural mistrust can be reached through assessment. Developed by Terrell and Terrell (1981), the Cultural Mistrust Inventory (CMI) is the most widely used instrument to assess cultural mistrust. Accurate assessment of cultural mistrust is necessary in order to eliminate other potential causes of reluctance in African Americans applying for or receiving services.

In terms of Lazarus's (1989) behavior modality, African American clients high in cultural mistrust may avoid/limit interactions or self-disclosures with Whites. Since Whites are the fear-inducing stimulus, the rehabilitation professional may consider having the African American client confront the fear by arranging encounters with Whites clients. For example, the participation of African American clients in an ethnically diverse (e.g., White, Asian, African American) counseling group may serve to reduce fear and suspicion stemming from miseducation and lack of exposure. In addition, modeling of self-disclosure can occur through observation of sharing and openness by the group participants. Within the group context, African American clients' rationale for cultural mistrust could be heard and challenged constructively. For example, successful African American clients can be included in the group to serve as a direct contradiction to cultural mistrust beliefs such as "Rehabilitation is just like all other White institutions. There's no way I'll succeed."

From an affective perspective, African American clients with disabilities and high cultural mistrust may feel a sense of powerlessness and lack of control because of uncertainties about how information about them is to be used by White rehabilitation professionals. Moreover, cultural mistrust of Whites by African Americans may be heightened if they feel placed in either an inferior position or a position that may single them out simply because of their ethnicity. An attempt should be made to erase the mystery about rehabilitation. African Americans with disabilities are likely to feel more in control if they are made aware of every aspect of the rehabilitation process. Assertiveness training should be considered by rehabilitation professionals as a strategy to encourage African American clients to express their concerns whenever they feel suspicious or vulnerable (Nystul, 1993).

With respect to imagery, cultural mistrust in African Americans may result from recurring images of negative events in the African American community (Ridley, 1984). For instance, clients may have constant images of the violence inflicted upon Rodney King by White police officers. The Rodney King incident may be perceived as evidence of malevolence by Whites toward African Americans. In particular, clients may envision themselves being the victims of similar mistreatment. Rehabilitation professionals are encouraged to use cognitive-behavioral techniques (Nystul, 1993) with clients to counter recurring negative images. For example, "thought-stopping" may be an effective technique for reducing the occurrence of negative images. African Americans can be taught to say "stop" to themselves whenever a negative image of Whites emerges in their thoughts. In addition, the counselor provides the client with a more accurate and positive perspective concerning the genesis of the negative thought. Cognitive-behaviorists believe that the repeated saying of "stop" along with the conjuring of a positive perception during negative images help to reduce the occurrence of those images by reconditioning the thought-processing of the individual to think more positively about a particular individual or situation.

Similarly, African American clients experiencing cultural mistrust may engage in irrational self-talk (Ridley, 1984). For example, clients may tell themselves: "All Whites are oppressors;" All of my problems exist because I'm Black"; or "Blacks are inferior to Whites." Rational disputation through healthier logic and corrective self-talk (e.g., "My ethnicity is not the blame for all of my problems;" "I am proud of my ethnicity") can be effective techniques in helping clients combat maladaptive self-talk (Nystul, 1993).

Conclusion

Cultural mistrust is one of several characteristics of African Americans with disabilities that may influence the manner in which they approach the rehabilitation system and interact with its professionals. The fundamental Rogerian practices of expressing unconditional positive regard, displaying genuineness, and demonstrating empathic understanding are particularly important to diminishing counterproductive effects of cultural mistrust in African Americans with disabilities. Ideally, the likelihood of rehabilitation entry and success for African American clients will be greatly enhanced by professional awareness concerning cultural mistrust and knowledge of strategies to control its effects on the rehabilitation process.

It is important to note that cultural mistrust is not intrinsically negative. Existence of the trait in a mild form has been suggested to be healthy and adaptive for African Americans (Grier & Cobbs, 1968; Triandis, 1976). Grier and Cobbs (1968) asserted that cultural mistrust in African Americans fosters "healthy paranoia" that sharpens social wits and enhances survival. Therefore, rehabilitation professionals are encouraged to avoid hasty overinterpretations of cultural mistrust as a malignant personality inadequacy.

Although the present authors are suggesting that cultural mistrust may restrain African Americans' rehabilitation interest and enthusiasm, no evidence exist to substantiate this assertion. Research is needed to specify the degree and nature of cultural mistrust in African Americans with disabilities. For example, how does cultural mistrust correlate with environmental setting, age, gender, and socioeconomic level of African Americans with disabilities? Moreover, which aspects (e.g., self-disclosure) of the helping process in rehabilitation for African Americans are affected most by cultural mistrust? It is postulated that research addressing cultural mistrust will enhance rehabilitation professionals' understanding of factors influencing African Americans' perception of rehabilitation. Consequently, there may be greater likelihood of African American participation and success in rehabilitation services.

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