150 the Behavior Therapist
gating usual mental health care. Adminis-
tration and Policy in Mental Health, 37,
Henggeler, S. W., &Borduin, C. M. (1990).
Family therapy and beyond: Amultisys-
temic approach to treating the behavior
problems of children and adolescents.
Pacific Grove, CA: Brooks/Cole.
Higa-McMillan, C. K., Powell, C., Dalei-
den, E. L., &Mueller, C. W. (2011). Pur-
suing an evidence-based culture through
contextualized feedback: Aligning youth
outcomes and practices. Professional Psy-
chology: Research and Practice, 42(2),
Kazdin, A. E. (2008). Evidence-based
treatment and practice: New opportuni-
ties to bridge clinical research and prac-
tice, enhance the knowledge base, and
improve patient care. American Psycholo-
gist, 63(3), 146-159. doi:10.1037/0003-
Lambert, M. J., Harmon, C., Slade, K.,
Whipple, J. L., &Hawkins, E. J. (2005).
Providing feedback to psychotherapists
on their patients’ progress: Clinical
results and practice suggestions. Journal
of Clinical Psychology, 61(2), 165–174.
Novak, G. M., Patterson, E. T., Gavrin, A.
D., Christian, W., &Forinash, K. (1999).
Just in time teaching. American Journal
of Physics, 67(10), 937-938. doi:
Patient Protection and Affordable Care
Act, Pub. L. No. 111 –148, §2702, 124
Stat. 119, 318-319 (2010).
Reese, R. J., Norsworthy, L. A., &Row-
lands, S. R. (2009). Does acontinuous
feedback system improve psychotherapy
outcome? Psychotherapy Theory,
Research, Practice, Training, 46(4), 418–
Schoenwald, S. K. (1998). Multisystemic
therapy consultation manual.Charleston,
SC: The MST Institute.
Schoenwald, S. K., Sheidow, A. J., &Chap-
man, J. E. (2009). Clinical supervision in
treatment transport: Effects on adher-
ence and outcomes. Journal of Consulting
and Clinical Psychology, 77(3), 410–421.
Shoham, V., Rohrbaugh, M. J., Onken, L.
S., Cuthbert, B. N., Beveridge, R. M., &
Fowles, T. R. (2014). Redefining clinical
science training: Purpose and products of
the Delaware Project. Clinical Psychologi-
cal Science, 2(1), 8-21. doi:10.1177/
Southam-Gerow, M. A., &Dorsey, S.
(2014). Qualitative and mixed methods
research in dissemination and imple-
mentation science: Introduction to the
special issue. Journal of Clinical Child &
Adolescent Psychology, 43(6), 845–850.
Weingardt, K. R. (2004). The role of
instructional design and technology in
the dissemination of empirically sup-
ported, manual-based therapies. Clinical
Psychology: Science and Practice, 11(3),
313–331. doi: 10.1093/clipsy/bph087
Wu, J. H., &Wang, S. C. (2005). What
drives mobile commerce?: An empirical
evaluation of the revised technology
acceptance model. Information &Man-
agement, 42(5), 719-729. doi:10.1016/j.
Correspondence to Todd E. Brown, M.A.,
University of California, Los Angeles,
Department of Psychology, 1285 Franz
Hall, Box 951563, Los Angeles, CA 90095
AS OF 2010, NON-HISPANIC WHITES com-
prised 63% of the U.S. population, yet the
number of minority psychologists lingers
under 25% (American Psychological Asso-
ciation [APA], 2010; U.S. Census Bureau,
2011). The limited data available on psy-
chologist demographics is encouraging
insofar as APA membership is shifting to
include greater numbers of ethnic and
racial minorities in its various membership
categories. Even so, the rate at which eth-
noracially diverse populations seek mental
health services is outpacing the availability
of minority psychologists. Ethnic and racial
minorities are projected to exceed 57% of
the population by 2060 as non-Hispanic
White Americans become aminority over
the next three decades (U.S. Census
Bureau, 2012). As a result, ethnoracially
diverse therapy dyads are increasingly
common. This growth in diversity acceler-
ates the need for ongoing scholarship,
informed attitudes, and clinician compe-
tency for multicultural clinical training at
parity with other important therapeutic
Discrimination resulting from stigma-
tized minority status is associated with neg-
ative mental health outcomes, such as
depression, anxiety, substance use, post-
traumatic stress disorder, and overall psy-
chological distress (Banks &Kohn-Wood,
2007; Blume, Lovato, Thyken, & Denny,
2012; Chae, Lincoln, & Jackson, 2011;
Pieterse, Todd, Neville, &Carter, 2012). As
a result, such experiences and the related
psychological sequelae may require
focused clinical attention (e.g., Williams,
Gooden, & Davis, 2014). Additionally,
research indicates that the adaptation of
cognitive-behavioral therapies (CBT) for
cultural competency may be superior to
nonadapted CBT (Kohn, Oden, Munoz,
Robinson, &Leavitt, 2002; Miranda et al.,
2003). Thus, the mental health community
is ethicallyboundto cultivatemulticultural
competency and continue investigating
empirically supported treatments for
diverse populations (Constantine, Miville,
&Kindaichi, 2008; Ridley, 1985; Sue, Zane,
Hall, &Berger, 2009).
This need is met with a host of chal-
lenges as many therapists are unprepared
to address cultural issues due to inadequate
multicultural education and/or social
taboos surrounding racism, discrimina-
tion, and White privilege (Neville, Wor-
thington, &Spanierman, 2001; Terwilliger,
Using Functional Analytic Psychotherapy to
Improve Awareness and Connection in Racially
Diverse Client-Therapist Dyads
Annette Miller and Monnica T. Williams, University of Louisville
Chad T. Wetterneck, Rogers Memorial Hospital
Jonathan Kanter and Mavis Tsai, University of Washington, Seattle
September •2015 151
Celebrating Its 43rd Anniversary
Steven T. Fishman, Ph.D., ABPP |Barry S. Lubetkin, Ph.D., ABPP
Directors and Founders
Since 1971, our professional staff has treated over 30,000 patients with compassionate, empirically-based CBT.
Our specialty programs include: OCD, Social Anxiety Disorder, Panic Disorder, Depression, Phobias, Personality
Disorders, and ADHD-Linked Disorders, and Child/Adolescent/Parenting Problems.
Our externs, interns, post-doctoral fellows and staff are from many of the area’s most prestigious universities
specializing in CBT, including: Columbia, Fordham, Hofstra, Rutgers, Stony Brook, St. John’s, and Yeshiva
Conveniently located in the heart of Manhattan just one block from Rockefeller Center. Fees are affordable,
and a range of fees are offered.
New York City
INSTITUTE for BEHAVIOR THERAPY
Forreferrals and/orinformation,pleasecall: (212)692-9288
20 East 49thSt., SecondFloor, New York, NY 10017
e-mail: firstname.lastname@example.org | web: www.ifbt.com
Bach, Bryan, & Williams, 2013). There is
currently no standardized training model
for multicultural competency. Although a
handful of scholars have devoted signifi-
cant energy to measuring multicultural
competency, training for therapists to
engage clients of diverse racial, ethnic, and
cultural backgrounds may remain inade-
quate (Worthington, Soth-McNett, &
Moreno, 2007). One systematic review
found that although multicultural training
made clinicians feel more knowledgeable,
there was poor evidence that patient out-
comes were improved; furthermore, the
vast majority of programs omitted the con-
cepts of racism, bias, or discrimination
from their content (Price et al., 2005).
Matching by racial group has been one
approach used to serveethnoracialminori-
ties seeking mental health services. Propo-
nents of matching point to an elevated per-
ception of multicultural awareness,
treatment retention, and client preference
(Lee, Sutton, France, & Uhlemann, 1983;
Meyer &Zane, 2013). However, matching
may oversimplify both the client’s and clin-
ician’s experience as it assumes a high
degree of similarity in backgrounds, values,
level of assimilation, religion, and language
(Williams, Chasson, &Davis, 2015). It may
also remove acritical opportunity for client
and clinician to grow and connect as they
learn to appreciate differences in cultural
values and experiences. Although match-
ing is preferred by most clients, alliance,
skill, knowledge of client culture, ethnicity,
and race appear to have agreater impact on
positive therapeutic outcomes (Cabral &
Smith, 2011). Most recently, Ibaraki and
Hall (2014) examined ethnic matching,
finding it functions as a proxy for shared
culture, where common values and closely
held beliefs influence the content minority
clients discuss in therapy. This suggests
therapeutic outcomes are linked to the clin-
ician’s ability to understand the client’s
perspective and cultural background
(Flicker, Waldron, Turner, Brody, &Hops,
One risk in diverse dyads is uninten-
tionally stigmatizing the client. Lack of
insight about the client’s cultural, racial, or
ethnic identity might result in inadvertent
microaggressions or other expressions of
bias; this may alienate the client, threaten
the therapeutic relationship, impede treat-
ment progress, and increase risk of early
dropout (Constantine, 2007; Sue,
Capodilupo, Torino, & Bucceri, 2007).
Additionally, when culturally normative
behaviors are not considered in treatment,
therapists risk misdiagnosing minority
clients (Chapman, DeLapp, & Williams,
2014). Rather than adopting acolor blind
approach, which discourages the client
from expressing their experiences as a
racialized minority and exploring protec-
tive factors (Terwilliger et al., 2013), thera-
pists can benefit the relationship by bring-
ing this part of the client’s experience into
therapy. To do this effectively, therapists
must first understand their own relation-
ship to diverse groups and acknowledge
race as asocial power construct (Cardemill
&Battle, 2003). By building on this attune-
ment to social power and privilege, thera-
pists can benefit from experiential learning
to explore their own feelings, beliefs, and
attitudes about race, ethnicity, and culture,
to gain greater cross-racial understanding
(Devereaux, 1991; Okech & Champe,
2008). In describing the experiential
process of growth and change, McKinney
(2006) found that “most of the turning
152 the Behavior Therapist
point experiences involved aWhite person
first coming into sustained contact with
persons of color.” Similarly, cross-racial
friendships have been found to enhance
cross-racial therapeutic relationships
(Okech & Champe). Taken together, this
suggests experiential contact and closeness
with diverse populations may expand clin-
Functional Analytic Psychotherapy
Functional analytic psychotherapy
(FAP), an approach rooted in the contex-
tual behavioral tradition (Hayes et al.,
2012), focuses on the therapeutic relation-
ship as the agent of change to improve the
client’s outside relationships (Tsai et al.,
2009). It is similar to many CBT interven-
tions because it focuses on concrete behav-
ioral change and includes homework
assignments, but it differs with respect to
the amount of time and attention given to
building astrong therapeutic relationship
that serves as the primary vehicle for client
change. Abasic position of FAP is that the
therapeutic relationship is a genuine
human relationship. This relationship is
powerful in promoting learning and
change, fostering motivation, and keeping
clients engaged in treatment and adherent
to treatment plans.
FAP promotes increased awareness
both in the client and the therapist. FAP
therapists take interpersonal risks by expe-
riencing, processing, and disclosing reac-
tions to the client immediately as they
occur in-session in the service of client
growth and, in turn, encourage their clients
to do the same. When the client engages in
courageous self-expression in session, the
therapist responds withgenuinefeedback
to increase theconnection throughthe
exchange. This vulnerability and immedi-
acy serves as a model to help the client
improve connections with others, which is
an important transdiagnostic outcome
(Wetterneck & Hart, 2012). In this way,
FAP provides a complement to peer sys-
tems’ techniques such as psychoeducation,
cognitive restructuring, behavioral experi-
ments, and exposure.
FAP leverages five core principles, or
rules, to conceptualize client behaviors,
evaluate their functions, and conditionally
change or reinforce behaviors through the
interpersonal dynamics in the dyadic rela-
tionship (Tsai, Callaghan, & Kohlenberg,
2013; Tsai, McKelvie, Kohlenberg, &
Kanter, 2014). These client behaviors are
identified as clinically relevant behaviors,
or CRBs (see Figure 1). Maladaptive CRBs
(CRB1s) and adaptive CRBs (CRB2s) are
identified collaboratively by both the ther-
apist and client and analyzed for function
at both the micro and macro level to
broadly understand and effect change in
the client (Tsai, Kohlenberg, Kanter,
Holman, &Plummer Loudon, 2012). Sim-
ilarly, therapist-relevant behaviors (TRBs)
have a clinically relevant impact in treat-
ment as well.
Recent FAP writings have discussed
how the implementation of FAP’s five
behavioral rules may be supplemented
with an understanding of awareness,
courage, and therapeutic love towards
clients (Tsai et al., 2009; Tsai et al., 2012).
The first rule of FAP centers on awareness
of how a client’s CRBs appear in session
and promotes self-awareness as well,
including awareness of one’s attitudes,
biases, and assumptions about the client.
The second rule is that clinicians evoke
CRBs in therapy, and this may at times
involve being courageous and vulnerable
with clients. The third rule centers on being
therapeutically loving to reinforce positive
CRBs while challenging maladaptive CRBs.
As behaviors are exhibited in-session, the
fourth rule calls for the therapist to be
aware of their impact on clients, both as a
clinician and as aperson. Finally, the fifth
rule calls on the therapist to facilitate gen-
eralization of in-session client behavior
changes to promote sustainable change in
the client’s life. FAP is particularly well-
suited for culturally sensitive CBT and clin-
ician growth because of its focus on the
relationship as a primary change mecha-
nism, and FAP is flexible enough to be used
for analyzing the functions of behaviors in
client-specific content across cultures and
ethnicities (Vanderburghe, 2008).
All therapists stand to gain increased
competency across treatment approaches,
settings, goals, and client backgrounds
using an authentic and culturally sensitive
approach. Below we describe examples of
common challenges therapists experience
when working in racially and ethnically
diverse therapist-client dyads and how they
might be addressed using FAP interven-
Differences With Clients
Race is one of the first features per-
ceived when encountering a new person,
yet despite the obvious differences in an
unmatched dyad, many therapists are
uncomfortable discussing race (Knox,
2007). FAP emphasizes the unique history
of each client, and, for minority clients,
ethnic and racial identity are an important
part of this history that should be addressed
early in treatment. Therapeutic awareness,
acceptance, and exploration of discomfort
related to racial differences in the service of
client growth can be an important shift
toward therapist growth that ultimately
bolsters trust and connection with the
client. Although it may be anxiety-provok-
ing for therapists who have previously
avoided such discussions to address racial
differences, acknowledging diversity in the
therapeutic relationship is likely to result in
greater satisfaction and connection with
minority clients, as it demonstrates cultural
sensitivity (Neville, Tynes, &Utsey, 2009).
Working to understand aclient’s potential
struggles with identity, self-concept, and
intersectionality may mediate feelings of
Figure 1. Clinically relevant behaviors
September •2015 153
invisibility often reported by racial and
ethnic minorities, and correspondingly,
acknowledging cultural strengths, such as
collectivism and racial pride, can promote
resilience in the face of challenge (Franklin,
1999; Hays, 2009).
Failure to UnderstandWhite Privilege
As a culture, we are socialized not to
acknowledge Whiteness and the power and
unearned privilege it affords (Neville et al.,
2001). As aresult, therapists are often con-
fused and uncomfortable with related
topics, such as discrimination, racism, and
stigmatized minority status. Acknowledg-
ing unearned privilege may provoke guilt,
shame, and defensiveness. FAP, because it
locates the source of this problem in our
social context and not in the individual,
allows therapists to increase awareness and
exploration of White privilege and differ-
ential access to important reinforcers (e.g.,
money, education, promotions) as aresult
of differences in power and privilege.
Deliberate self-disclosure of this status,
when used in the service of client growth,
may be linked to higher levels of trust and
perceived sensitivity in ethnic minority
clients and improvements in the quality of
the therapeutic relationship (Constantine
& Kwan, 2003; Tsai et al., 2009). Indeed,
privilege and social group membership are
inseparable components of the emergent
therapeutic context (Terry, Bolling, Ruiz, &
Brown, 2010). For a White therapist,
admitting to astigmatized minority client
that the therapist has benefited from race in
away that the client has not, and to exhibit
a willingness to change behaviors that
maintain power and privilege (e.g., have a
sliding fee scale, being open to learning
more about indigenous therapies such as
soul retrieval for Native Americans) exem-
plify a commitment to genuineness that
can promote authenticity, growth, and
Endorsing StereotypicalBeliefs About
Because of pervasive negative social
messages about ethnic and racial minori-
ties, we tend to make automatic and inac-
curate judgments about others based on
pathological stereotypes, which in turn lead
to microaggressions (Blair, Judd, & Fall-
man, 2004; Williams et al., 2012). Microag-
gressions committed by therapists have
been demonstrated to be asignificant pre-
dictor of dissatisfaction with the therapeu-
tic experience (Constantine, 2007) and pre-
sent significant barriers to FAP’s
fundamental and necessary intimate, trust-
ing, andsafe transactions that celebratethe
client’s expression of his/herfull self as an
ethnic and cultural being. It is helpful for
therapists to acknowledge their own ten-
dency to make unfair judgments and
demonstrate awillingness to reject stereo-
types. By being courageous enough to
admit alack of accurate knowledge about
important cultural, racial, or ethnic topics,
therapists can exhibit vulnerability and
seek understanding with clients in a
manner that will facilitate an open
exchange of information. FAP’s behavioral
and interpersonal techniques allow thera-
pists to admit they are not the authority on
all topics, such as the minority experience.
In this way, clinicians can begin to under-
stand the client’s daily life without relying
on stereotypes and subsequently reducing
the likelihood of committing harmful
It is not enough, however, just to admit
alack of cultural knowledge. It is important
Clinically Proven Treatment for Patients with Panic Disorder
The Freespira Breathing System addresses an important
physiological component for your patients with Panic Disorder.
The System trains patients to stabilize their respiratory pattern
and normalize their exhaled CO2 level. This changes the
body’s chemistry over time and reduces or eliminates the
symptoms of Panic Disorder, including panic attacks.
reduction in panic
symptoms at 12 months*
at 12 months*
*Based on StanfordUniversitySchool of Medicine,Southern Methodist University, etc. clinical trial data
!FDA-Cleared !Simple to learn
Drug-free !Easy to teach patients
Call to learn more (925) 594-8404
to remediate these deficits by seeking infor-
mation from sources other than clients, as
ethnic minorities often report feeling weary
of bearing the burden of educating others.
Furthermore, in order to minimize stereo-
typing clients, it is important to maintain
relentless emphasis on understanding the
cultural context of CRBs and the adaptive
functions of “problem” behaviors. For
example, what may be seen as “depen-
dence” and “enmeshment” by young Asian
clients with their families can be under-
stood within acultural context of emphasis
on interdependence and prioritizing family
needs over individual needs (Sue & Sue,
Failure of Therapistto Continually
Develop as an Instrumentof Change
FAP emphasizes that a therapist’s
potency as achange agent can be increased
by continually cultivating awareness of the
impact of one’s own history on potential
biases. It may be helpful to explore individ-
ually or in consultation group questions
such as the following:
What were your first experiences with
What were you told about others who
were ethnoracially different?
What were your earliest memories of
race or color?
What stereotypes do you hold of
What are your experiences as aperson
having or not having power in relation
to race or class?
What steps can you take to learn more
about your clients’ cultural back-
What are your preferred therapeutic
methods that may not be culturally
attuned or adequate?
How might you be inadvertently repeat-
ing negative or oppressive interactions
representing the dominant culture with
How can you make use of therapeutic
“mistakes” or microaggressions in ways
that increase therapeutic alliance?
What is difficult for you to address
regarding race, culture, or other differ-
ences you have with your clients?
Table 1lists afew examples of common
therapist issues surrounding race, ethnic-
ity, and culture (Daily Life Problems), how
the problem might look in a therapeutic
relationship (TRB1), and one way that a
therapist might overcome the problem
from aFAP perspective (TRB2).
As the scholar-clinician community
seeks to improve quality of care for every-
one, it is imperative that we acknowledge
the importance of multicultural knowledge
and skills. This includes an appreciation of
other psychological perspectives, such as
Afrocentric research, which is often viewed
critically rather than with respect (Delapp
& Williams, 2015). Future scholarship
should build on preliminary work to
enhance and measure therapist compe-
tence in diverse dyads (Constantine, 2008;
Daily Life Therapist Problem
Table 1. Therapist-Relevant Behaviors
Problem Behavior (TRB1) Goal Behavior (TRB2)
White therapist experiences
anxiety, agitation, and confu-
sion in response to racially
Referring a minority client
to another therapist of their
same ethnic background.
Expressing the feelings open-
ly with client and also recog-
nizing own potential bias or
lack of understanding.
Belief that discussing racial
issues beyond a superficial
level is a taboo.
Avoiding topics about race
or culture and redirecting
to a different topic when it
is culturally sensitive.
Asking the client if the dif-
ference in race is something
they would like to discuss,
while recognizing that it
might be uncomfortable.
White therapist denying
benefits experienced from
Whiteness because therapist
has not previously consid-
Denying or invalidating
client when this topic or
Acknowledging the unfair
and unearned benefits of
being White and validating
client if the topic arises.
White therapist ashamed of
his/her own ignorance on
Avoiding topics related to
race in order to hide own
Expressing feelings openly
and asking the client if/how
they would like to address
Taking steps to learn more
about applicable cultural
Therapist generalizing norms
of racial minorities based
upon assumptions and
Making assumptions in
session about problems
and not allowing client to
explain problems in his
or her own words.
Exploring problems with an
open mind and allowing
client to express how he or
she faces problems associated
Latino male therapist feeling
shame about his cultural
Being too deferential to
White clients due to
feelings of inferiority.
may have biases due to
learning history and being
aware and appropriately
assertive in session.
Black female therapist with
dark skin believes that fairer
skinned Black women are
arrogant and want to be
Hostility toward fair-
skinned Black female
Asking client about her expe-
riences as a fair-skinned
Black woman, and recogniz-
ing her own biases.
154 the Behavior Therapist
The ClinicalPrac6ce of Cogni6ve Therapy
October, 2015 – July, 2016
• Intensive, hands-on training that is usefulin clinical prac^ce
•Live & videotaped demonstra^ons
•Face-to-face one day a month or Distance Educa^on via Internet
Sponsored by: the Cleveland Center for CogniAve Therapy
For more informa^on:
or call 216-831-2500 x 2
Drinane, Owen, Adelson, & Rodolfa,
2014). Such investigations may reveal
where cultural competency constructs
diverge from general clinician compe-
tency, allowing training to better prepare
clinicians to work with diverse popula-
Furthermore, many training programs
may benefit from aformat that is curricu-
lum-integrated and experiential. To
answer the need for culturally adapted
CBT, we propose FAP for its integrative
principles of awareness, courage, and love.
Future research should investigate the use
of such skills, including clinician self-
awareness, immediacy, and connection
relative to therapeutic outcomes within
mismatched racial dyads. Remembering
that training is alifelong exercise for ther-
apists, FAP provides the additional benefit
of ongoing therapist self-discovery and
growth (Tsai et al., 2009). In anation built
on fused genealogies and cultures, it is
imperative that we advance an under-
standing and application of skills to
enhance treatment utilization, reduce pre-
mature dropout, and promote culturally
informed change. Every client is amicro-
culture, carrying deeply rooted cultural,
social, generational, and reinforcement
histories. The building blocks of inclusion,
racial equity, social justice and prosocial
change can begin within the therapeutic
alliance (Vandenberghe et al., 2010).
American Psychological Association.
(2010, January). 2010:Race/ethnicityof
doctorate recipients in psychologyin the
past 10 years.Retrieved from:
Banks,K., &Kohn-Wood, L. (2007). The
influence of racialidentity profiles on the
relationship between racial discrimina-
tion and depressive symptoms.Journal
of Black Psychology, 33,331–354.
Blair,I. V., Judd,C. M., &Fallman, J. L.
(2004). The automaticity of race and
Afrocentricfacialfeatures in social judg-
ments.Journal of Personality and Social
Blume, A. W., Lovato, L. V., Thyken, B.
N., &Denny,N. (2012). The relationship
of microaggressions with alcohol use and
anxiety among ethnic minority college
students in ahistorically white institu-
tion. Cultural Diversity &Ethnic Minor-
ity Psychology, 18,45–54.
Cabral, R. R., &Smith,T. B. (2011).
Racial/ethnic matching of clients and
therapistsin mental healthservices: A
meta-analytic review of preferences, per-
ceptions, and outcomes.Journal of Coun-
selingPsychology, 58(4), 537-554.
Cardemil,E. V., &Battle, C. L. (2003).
Guess who’s coming to therapy? Getting
comfortable with conversationsabout
race and ethnicity in psychotherapy.
Professional Psychology:Research and
Chae,D. H., Lincoln, K. D., &Jackson, J. S.
(2011). Discrimination, attribution, and
for psychological distress amongBlack
Americansin the National Survey of
American Life (2001–2003). American
Journal of Orthopsychiatry,81,498–506.
Chapman, L. K., DeLapp, R., &Williams,
M. T. (2014). Impactof race,ethnicity,
and culture on the expression and assess-
ment of psychopathology. In D. C.
Beidel, B. C. Frueh, &M. Hersen (Eds.),
Adultpsychopathologyand diagnosis (pp.
131-162). Hoboken, NJ: John Wiley.
Constantine, M. G. (2007). Racial
microaggressions against African Ameri-
can clients in cross-racial counseling
relationships. Journal of Counseling
Constantine, M. G., &Kwan,K.-L.K.
(2003.) Cross-cultural considerations of
therapistself-disclosure. Journal of Clini-
cal Psychology, 59,581–588. doi:
Constantine, M.G.,Miville, M. L., &
Kindaichi, M.M. (2008). Multicultural
competencein counseling psychology
practice and training.In S. D. Brown &
R. W. Lent,(Eds.), Handbook of counsel-
ing psychology(pp. 141–158.). New York:
Delapp, R. C., &Williams,M. T. (2015).
Professional challengesfacing African
American psychologists:The presence
and impact of racial microaggressions.
the Behavior Therapist, 38(4), 101-105.
Devereaux,D. (1991). The issueof race
and the client-therapist assignment.
Issues in Mental Health Nursing, 12,283-
Drinane, J.M.,Owen,J., Adelson, J.L., &
Rodolfa, E. (2014). Multiculturalcompe-
tencies: What are we measuring?
Flicker, S., Waldron, H., Turner, C.,
Brody, J., &Hops,H. (2008). Ethnic
matching and treatmentoutcome with
Hispanic and Anglosubstance-abusing
adolescents in family therapy. Journal of
Family Psychology, 22(3),439-447.
Franklin,A. J. (1999). Invisibility syn-
dromeand racial identity development
in psychotherapy and counseling African
American men. CounselingPsychologist,
Hayes, S. C., Barnes-Holmes, D., &
Wilson, K. G. (2012). Contextual behav-
ioralscience: Creating ascience more
adequate to the challenge of the human
condition. Journal of ContextualBehav-
Hays,P. A. (2009). Integrating evidence-
apy, and multiculturaltherapy: Ten steps
for culturally competentpractice.Profes-
sional Psychology: Research and Practice,
Ibaraki, A., &Hall,G. (2014). The compo-
nentsof cultural matchin psychother-
apy. Journal of Social and Clinical Psy-
chology, 33(10), 936-953.
Knox,R. (2007). Experiencing risk in
person-centred counselling: Aqualitative
exploration of therapist risk-taking.
British Journal of Guidance &Coun-
Kohn, L. P., Oden,T., Munoz, R. F.,
Robinson,A., &Leavitt, D. (2002).
Adapted cognitivebehavioral group
therapy for depressedlow-income
African American women. Community
Mental Health Journal, 38(6), 497–504.
Lee, D., Sutton, R., France, H., &Uhle-
mann,M. (1983). Effects of counselor
race on perceivedcounseloreffective-
September •2015 155
156 the Behavior Therapist
ness. Journal of Counseling Psychology,
McKinney, K. D. (2006.) ‘I really felt
white’: Turning points in whiteness
through interracial contact. Social Identi-
ties, 12(2), 167-185.
Meyer, O. L., &Zane, N. (2013). The influ-
ence of race and ethnicity in clients’
experiences of mental health treatment.
Journal of Community Psychology, 41(7),
Miranda, J., Azocar, F., Organista, K.,
Dwyer, E., &Areane, P. (2003). Treat-
ment of depression among impoverished
primary care patients from ethnic minor-
ity groups. Psychiatric Services, 54,219–
Neville, H. A., Tynes, B. M., &Utsey, S. O.
(2009). Handbook of African American
psychology.Thousand Oaks, CA: Sage.
Neville, H., Worthington, R., &Spanier-
man, L. (2001). Race, power, and multi-
cultural counseling psychology: Under-
standing White privilege and color blind
racial attitudes. In J. Ponterotto, M.
Casas, L. Suzuki, &C. Alexander (Eds.),
Handbook of multicultural counseling
(pp. 513-522). Thousand Oaks, CA: Sage.
Okech, J. E. A., &Champe, J. (2008).
Informing culturally competent practice
through cross-racial friendships. Interna-
tional Journal for the Advancement of
Pieterse, A., Todd, N. R., Neville, H. A., &
Carter, R. T. (2012). Perceived racism
and mental health among Black Ameri-
can adults: Ameta-analytic review. Jour-
nal of Counseling Psychology, 59,1–9.
Price, E. G., Beach, M. C., Gary, T. L.,
Robinson, K. A., Gozu, A., Palacio, …
Cooper, L. A. (2005). Asystematic review
of the methodological rigor of studies
evaluating cultural competence training
of health professionals. Academic Medi-
cine, 80(6), 578-586.
Ridley, C. R. (1985). Imperatives for ethnic
and cultural relevance in psychology
training programs. Professional Psychol-
ogy: Research and Practice, 16(5), 611–
Sue, D. W., Capodilupo, C. M., Torino, G.
C., &Bucceri, J. M. (2007). Racial
microaggressions in everyday life: Impli-
cations for clinical practice. American
Psychologist, 62(4), 271-286.
Sue, D. W., &Sue, D. (2008). Counseling
the culturally diverse: Theory and prac-
tice. Hoboken, NJ: John Wiley &Sons.
Sue, S., Zane, N., Nagayama Hall, G. C., &
Berger, L. K. (2009). The case for cultural
competency in psychotherapeutic inter-
ventions. Annual Review of Psychology,
Terry, C., Bolling, M. Y., Ruiz, M.R., &
Brown, K. (2010). FAP and feminist ther-
apies: Confronting power and privilege
in therapy. In J. W. Kanter, M. Tsai, &R.
J. Kohlenberg (Eds.), The practice of func-
tional analytic psychotherapy (pp. 97-
122). New York, NY: Springer.
Terwilliger, J. M., Bach, N., Bryan, C., &
Williams, M. T. (2013). Multicultural
versus colorblind ideology: Implications
for mental health and counseling. In A.
Di Fabio (Ed.), Psychology of counseling.
New York, NY: Nova Science.
Tsai, M., Callaghan, G., &Kohlenberg, R.J.
(2013). The use of awareness, courage,
therapeutic love, and behavioral inter-
pretation in Functional Analytic Psy-
chotherapy. Psychotherapy, 50(3), 366-
Tsai, M., Kohlenberg, R.J., Kanter, J.,
Holman, G., &Plummer Loudon, M.
(2012). Functional Analytic Therapy: Dis-
tinctive features. London: Routledge.
Tsai, M., Kohlenberg, R.J., Kanter, J.W.,
Kohlenberg, B., Follette, W.C., &
Callaghan, G.M. (2009). Aguide to func-
tional analytic psychotherapy: Awareness,
courage, love, and behaviorism.New
York, NY: Springer.
Tsai, M., McKelvie, M., Kohlenberg, R., &
Kanter, J. (2014). Functional analytic psy-
chotherapy: Using awareness, courage and
love in treatment.Society for the
Advancement of Psychotherapy.
Retrieved from http://societyforpsy-
U.S. Census Bureau. (2011). Overview of
race and Hispanic origin: 2010.2010
Census Briefs. Retrieved from:
U.S. Census Bureau. (2012). U.S. Census
Bureau projections show aslower grow-
ing, older, more diverse nation ahalf cen-
tury from now.Retrieved from:
Vandenberghe, L. (2008). Culture-Sensi-
tive Functional Analytic Psychotherapy.
The Behavior Analyst, 31(1), 67–79.
Vandenberghe, L., Tsai, M., Valero, L.,
Ferro, R. Kerbauy, R., Wielenska, R., ...
Muto, T. (2010). Transcultural FAP. In J.
Kanter, M. Tsai, &R. J. Kohlenberg
(Eds.), The practice of functional analytic
psychotherapy (pp. 173-185). New York,
Wetterneck, C.T., &Hart, J.M. (2012).
Intimacy is atransdiagnostic problem for
cognitive behavior therapy: Functional
analytic psychotherapy is asolution.
International Journal of Behavioral Con-
sultation and Therapy, 7(2-3), 167-176.
Williams, M. T., Chasson, G. S., &Davis,
D. M. (2015). Anxiety and affect in
racially unmatched dyads during evalua-
tion and assessment. In A. M. Columbus
(Ed.), Advances in psychology research,
Volume 108.Hauppauge, NY: Nova Sci-
Williams, M. T., Gooden, A. M., &Davis,
D. (2012). African Americans, European
Americans, and pathological stereotypes:
An African-centered perspective. In G. R.
Hayes &M. H. Bryant, (Eds.), Psychology
of culture (pp. 25-46). Hauppauge, NY:
Williams, M. T., Malcoun, E., Sawyer, B.,
Davis, D. M., Bahojb-Nouri, L. V., &
Bruce, S. L. (2014). Cultural adaptations
of prolonged exposure therapy for treat-
ment and prevention of posttraumatic
stress disorder in African Americans.
Behavioral Sciences, 4(2), 102-124.
Worthington, R. L., Soth-McNett, A. M.,
&Moreno, M. V. (2007). Multicultural
counseling competencies research: A20-
Year content analysis. Journal of Counsel-
ing Psychology, 54 (4): 351-361.
Correspondence to Monnica Williams,
Ph.D., Center for Mental Health Dispari-
ties, University of Louisville, Department
of Psychological &Brain Sciences, 2301
South Third St., Louisville, KY 40292;
teaching resources |research resources |clinical resources
RESOURCES VISIT OUR FACEBOOK PAGE