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In Search of Cultural Competence in Psychotherapy and Counseling

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Abstract

The characteristics involved in cultural competency in psychotherapy and counseling have been difficult to specify. This article describes attempts to study factors associated with cultural competency and addresses 3 questions. First, is ethnic match between therapists and clients associated with treatment outcomes? Second, do clients who use ethnic-specific services exhibit more favorable outcomes than those who use mainstream services? Third, is cognitive match between therapists and clients a predictor of outcomes? The research suggests that match is important in psychotherapy. The cultural competency research has also generated some controversy, and lessons learned from the controversy are discussed. Finally, it is suggested that important and orthogonal ingredients in cultural competency are therapists' scientific mindedness, dynamic-sizing skills, and culture-specific expertise.
In Search of Cultural Competence in
Psychotherapy and Counseling
Stanley Sue
University of California, Davis
The characteristics involved in cultural competency in
psychotherapy and counseling have been difficult to
specify. This article describes attempts to study factors
associated with cultural competency and addresses 3
questions. First, is ethnic match between therapists and
clients associated with treatment outcomes? Second, do
clients who use ethnic-specific services exhibit more fa-
vorable outcomes than those who use mainstream ser-
vices? Third, is cognitive match between therapists and
clients a predictor of outcomes? The research suggests
that match is important in psychotherapy. The cultural
competency research has also generated some contro-
versy, and lessons learned from the controversy are dis-
cussed. Finally, it is suggested that important and orthog-
onal ingredients in cultural competency are therapists'
scientific mindedness, dynamic-sizing skills, and culture-
specific expertise.
C
ultural competence is one of the most discussed
concepts among scholars and practitioners inter-
ested in ethnic minority issues. Indeed, numerous
groups at local and national levels have been examining
the concept in trying to establish guidelines and standards
for the provision of mental health services to ethnic mi-
nority populations, especially with the advent of managed
care. Why is there such interest and enthusiasm? I believe
that there is a growing realization that competent thera-
pists and counselors must be cross-culturally competent.
Because of the multiethnic nature of U.S. society and
because of the increasingly frequent interactions Ameri-
cans have with people from throughout the world, skills
must be developed to effectively work with people from
different cultures. Furthermore, cultural competency rep-
resents an important philosophical shift in defining ethnic
and race relations, traditionally examined as a conflict
involving assimilation versus pluralism.
The assimilation position was an ideology that cul-
turally different groups should become incorporated into
a largely Anglo mainstream. Gordon (1978) referred to
this process as "Anglo-conformity," in which the desir-
ability is assumed of maintaining the English language
and English-oriented cultural patterns in American life.
(An earlier notion, "the melting pot," sought cultural and
biological merging but was less oriented toward Anglo-
conformity.) Although some assimilation has occurred
among the diverse groups in society, cultural and distinct
ethnic group traditions have persisted in U.S. society as
well as in many other societies. Assimilation has not
progressed very far, especially in what Gordon conceptu-
alized as "structural assimilation," that is, the systematic
inclusion of ethnics in the White, Anglo-Saxon, Protes-
tant social structure (cliques, churches, neighborhoods,
home-visit patterns, etc.). In contrast to the assimilation
position, those who advocated pluralism sought to recog-
nize the ethnic and cultural integrity of different groups
and the coexistence of groups in a pluralistic society. The
concept of pluralism, attacked by assimilationists and
melting-pot advocates, has also not fared well. Although
there is recognition that different cultural groups exist in
the United States, many in society fail to embrace plural-
ism as a desirable goal. Anti-immigration sentiments, the
push for English-only materials, and so forth may reflect
the opposition to pluralism.
Cultural competence (along with the broader con-
cept of multiculturalism) is the belief that people should
not only appreciate and recognize other cultural groups
but also be able to effectively work with them. In a way,
cultural competence is less controversial than assimila-
tion and pluralism--how can one argue against compe-
tencies of any kind? And, whereas assimilation and plu-
ralism are ideologies or philosophies of life, cultural
competency is skill-based--skills that should be in the
repertoire of all practicing psychologists (Hall, 1997).
Given the interest in cultural competency, it is important
to ask what the concept means. Is it old wine in new
bottles?
In this article, I discuss (a) problems in mental
health services, (b) attempts to study cultural competence
over a period of about a decade, (c) policy issues arising
Editor's note. Articles based on APA award addresses are given spe-
cial consideration in the American Psychologist's editorial selection
process.
A version of this article was originally presented as part of an
Award for Distinguished Contribution to Research in Public Policy
address at the 105th Annual Convention of the American Psychological
Association, Chicago, IL, August 1997.
Author's note. I am grateful for the assistance of Karen Kurasaki and
Shobha Srinivasan in providing me with constructive comments on an
earlier version of this article.
Correspondence concerning this article should be addressed to
Stanley Sue, Department of Psychology, University of California, Davis,
One Shields Avenue, Davis, CA 95616-8686. Electronic mail may be
sent to ssue@ucdavis.edu.
440 April 1998 ° American Psychologist
Copyright 1998 by the American Psychological Association, Inc. 0003-066X/98/$2.00
Vol. 53, No. 4, 440-448
from research, and (d) the meaning of cultural compe-
tence in psychotherapy and counseling. By "meaning,"
I am not referring to just its definition. The definition
can be simply stated, that is, one is culturally competent
when one possesses the cultural knowledge and skills of
a particular culture to deliver effective interventions to
members of that culture. Rather, I want to address the
essence or character, namely, what constitutes cultural
competence?
The Search for Cultural Competence
The impetus for cultural competence has been the inade-
quacy of services for members of ethnic minority groups
such as African Americans, American Indians, Asian
Americans, and Latinos. One of the most frequently cited
problems in delivering mental health services to ethnic
minority groups is the cultural and linguistic mismatches
that occur between clients and providers (see Aponte,
Rivers, & Wohl, 1995; Comas-Diaz & Griffith, 1988;
Jenkins, 1985; LeVine & Padilla, 1980; Pope-Davis &
Coleman, 1997; D. Sue, Ivey, & Pedersen, 1996; Trim-
ble & LaFromboise, 1985). Cultural differences can af-
fect the validity of assessment as well as the development
of therapist-client rapport, the therapeutic alliance, and
treatment effectiveness. Concerns regarding the problems
in cross-cultural counseling and psychotherapy prompted
the American Psychological Association (APA) to estab-
lish guidelines for the provision of psychological services
to members of ethnic minority groups (APA Office of
Ethnic Minority Affairs, 1993). The guidelines are
largely hortatory in effect and implicitly recognize the
difficulties in relationships between providers and clients.
In view of these problems, the investigators cited
earlier made a series of recommendations to facilitate the
provision of more culturally responsive treatments. The
recommendations included the necessity to know the cul-
ture of clients, to be sensitive and flexible in dealing with
clients, and to achieve credibility. It is interesting to note
that the recommendations were not derived from defini-
tive research findings but were based on theory involving
cultural match or fit. That is, services should be delivered
in ways that are consistent with the cultural background
of clients. Indeed, in two major reviews (Chambless et
al., 1996; S. Sue, Zane, & Young, 1994), not a single
rigorous study examining the efficacy of treatment for
any ethnic minority population was found. By "rigor-
ous," I am referring to research in which (a) pre- and
posttreatment outcomes are assessed for clients from one
or more ethnic groups; (b) clients are randomly assigned
to conditions, and control groups (e.g., no treatment, at-
tention-placebo, or different ethnic groups matched on
demographic characteristics other than ethnicity) are used
when appropriate; (c) type of treatment and ethnicity are
crossed when comparisons of outcomes by ethnicity and
treatment are made; (d) multiple, culturally cross-vali-
dated assessment instruments are used; (e) outcomes are
assessed over time; and (f) findings are replicated. Many
of these criteria were used by the APA Division 12 Task
Force on Psychological Interventions to evaluate empiri-
cally validated treatments (Chambless et al., 1996). Given
the lack of solid research on treatment outcomes for eth-
nic minority populations, it is not surprising that the
recommendations have been based on theory rather than
research. Parenthetically, because of the lack of solid
research, is it possible that ethnics are actually faring
well in the mental health system? The available evidence
suggests that this is not the case and that much can be
done to improve the provision of mental health services
to culturally diverse groups (S. Sue et al., 1994).
The Cultural Match Studies
Because of the lack of a solid research foundation, my
colleagues and I decided to systematically study charac-
teristics of cultural competence. Together with research-
ers at the National Research Center on Asian American
Mental Health and a whole host of graduate students, we
wanted to examine different facets of cultural compe-
tence. We were interested in three questions. First, when
therapists and clients are of the same ethnicity, are treat-
ment outcomes better than when therapists and clients
differ in ethnicity? Over the years, the mental health pro-
fessions have been criticized for not training more ethnic
minority therapists who can serve their own communities.
Is there evidence that ethnic clients benefit from seeing
ethnically similar therapists? Under what conditions is
ethnic match important? Match presumably may not be
effective for everyone, so it is important to determine the
conditions under which match is important. Second,
when ethnic clients utilize ethnic-specific services, are
outcomes better than if they utilize non-ethnic-specific
or mainstream services? Many ethnic-specific services
have been established throughout the country. Are these
services effective, and what is it about such services that
is effective? Third, when therapists and clients think in
the same manner (i.e., exhibit cognitive match), regard-
less of their ethnicity, are treatment outcomes better?
I begin with the first question regarding ethnic
match. Our study of ethnic match was based on thousands
of African American, Asian American, Mexican Ameri-
can, and White clients seen in the Los Angeles County
mental health system (S. Sue, Fujino, Hu, Takeuchi, &
Zane, 1991). The large data set enabled us to accomplish
what other researchers had not done, namely, to report
on large samples of different ethnic clients. The study
was intended to examine length of treatment, dropout
rates (after one session), and treatment outcomes (using
pre- and posttreatment Global Assessment Scale [GAS]
scores) as dependent measures. Specifically, we were in-
terested in finding out if therapist-client matches in eth-
nicity and language were associated with attending more
sessions, less dropping out, and more favorable treatment
outcomes. Length of treatment was considered to be an
important indicator of outcome because it is known to
be directly related to favorable treatment outcomes (Or-
linsky, Grawe, & Parks, 1994). Premature termination
was examined because in my previous studies (see S.
Sue, 1977), ethnic clients were found to drop out of
treatment at a rate of about 50% after the initial treatment
April 1998 American Psychologist 441
session. In the ethnic match study, we controlled for a
number of variables, including social class, initial level
of functioning, gender, age, and so forth. Results indi-
cated that Asian Americans--especially those who were
unacculturated--generally fared better in terms of more
sessions, less drop out, and better treatment outcomes
when they saw a therapist who was matched ethnically,
linguistically, or both. Similar effects were found for
Mexican Americans, although the effects were less dra-
matic. Ethnic matches were significantly related to at-
tending more sessions for African Americans and Whites;
Whites also had lower rates of premature termination
when they were ethnically matched, although match was
not associated with premature termination among African
Americans. When the results for number of sessions or
premature termination were statistically significant, most
of the effect sizes were large, indicating the clinical sig-
nificance of the findings.
Finally, treatment outcomes for African Americans
and Whites were not related to ethnic match. It is not
known why matching is related to outcomes for some
groups but not others. Perhaps, in this study (S. Sue et al.,
1991), the outcome measure--GAS--lacked sufficient
sensitivity to assess outcomes in a valid fashion. Thera-
pists provided subjective ratings on a 100-point scale of
the level of functioning of clients, and much variability
may have existed in the validity of the ratings given by
the numerous therapists. Alternatively, the importance of
ethnic match may heavily depend on the acculturation
level, ethnic-cultural identity, or ethnicity of clients. For
some clients in the same ethnic minority group, match
may be quite important. It is known that ethnic or lan-
guage matches do not ensure cultural matches, which
may be of major importance. That is, ethnicity is more
of a demographic variable than a psychological variable.
The psychological aspects (e.g., identity, attitudes, be-
liefs, and personality) may be of greater importance.
My colleagues and I also examined the outcomes of
ethnic minority clients who used either ethnic-specific
services or mainstream services (Takeuchi, Sue, & Yeh,
1995; Yeh, Takeuchi, & Sue, 1994). Ethnic-specific ser-
vices are those that have a large ethnic clientele and
presumably try to respond to the cultural needs of clients.
They may respond by improving the accessibility of ser-
vices to ethnic minorities (e.g., by providing flexible
hours or placing treatment facilities in ethnic communi-
ties) and employing bicultural-bilingual staff. Various
practices (e.g., ways of greeting clients) or arrangements
(e.g., serving tea rather than coffee to Chinese clients)
may be used that are congruent with the cultural back-
ground of clients. Ethnic-specific services may also mean
that therapeutic practices are modified or developed so
that the cultural customs, values, and beliefs of clients
are considered (including in treatment indigenous healers
or religious leaders in the community, increasing partici-
pation of family members, etc.).
To study ethnic-specific services, we (Takeuchi et
al., 1995; Yeh et al., 1994) again examined the return
rates, length of treatment, and treatment outcomes of eth-
nic minority adults. This time, however, African Ameri-
can, Asian American, and Mexican American clients were
divided into those who received services from ethnic-
specific programs and those who attended mainstream
programs. Predictor variables included type of program
(ethnic-specific vs. mainstream), severity of disorder,
gender, age, social class, and ethnic match (whether or
not clients had a therapist of the same ethnicity). This
last variable, ethnic match, was important to enter as a
predictor to distinguish the effects of service match from
ethnic match. The results indicated that ethnic clients
who attended ethnic-specific programs had lower dropout
rates and stayed in the programs longer than did those
using mainstream services. The findings were not clear-
cut when treatment outcomes were examined. That is,
treatment outcomes, as measured by the GAS, failed to
show consistent or significant differences. However, the
fact that ethnic-specific services were associated with
lower dropout rates is important. As discussed earlier, a
great deal of concern has been generated over the ten-
dency for ethnic minority clients to prematurely drop out
of treatment and to attend, on average, fewer treatment
sessions (S. Sue, 1977), especially because treatment out-
come has consistently demonstrated a direct relationship
with the number of sessions in treatment (Orlinsky et al.,
1994). The fact that clients stay in treatment longer may
mirror the greater rapport, comfort, or cultural consis-
tency of ethnic-specific services.
It should be noted that in investigations of ethnic
match and ethnic-specific services match, the processes
that account for the results are unknown. Why is ethnic
match beneficial? Why do clients stay in treatment longer
when using ethnic-specific services? Unfortunately, my
colleagues and I could not randomly assign clients to
therapists or services, and we could not directly examine
process variables. However, it is noteworthy that the em-
pirical results suggest that cultural match and treatment
outcomes are related, a relationship hypothesized for
many years by numerous ethnic practitioners and
researchers.
In our search to define cultural competence, my
colleagues and ! have tried to study variables at a more
micro level than for ethnic or services match. At the
micro level, our interest was in cognitive match, that is,
whether therapist-client similarity in thinking is associ-
ated with better treatment outcomes. Therapists and cli-
ents often have different explanatory models for clients'
problems in terms of etiology, symptom meaning, course,
and appropriate treatment (Kleinman, 1980). S. Sue and
Zane (1987) argued that therapist-client differences in
cultural attitudes and beliefs affect the process and effi-
cacy of psychotherapy. We wanted to see if matches be-
tween therapists and clients in how they conceptualized
goals for treatment and means for resolving problems
would be more beneficial than mismatches. We also ex-
amined the match between therapists and clients in levels
of acculturation. Measures of therapists' and clients' be-
liefs regarding goals for treatment, preferred means for
resolving problems, and acculturation were collected at
442 April 1998 American Psychologist
a mental health center in San Francisco. The degree of
match between therapists and clients was then used as
a predictor of posttreatment symptoms, adjustment, and
clients' ratings of the treatment sessions, after controlling
for pretreatment status.
In view of the large numbers of analyses for the
numerous criterion measures and their subscales, I pro-
vide a summary of the results that are currently still being
analyzed. There is evidence that match is significantly
related to treatment outcome and clients' perceptions of
the sessions. In various comparisons, therapist-client
matches on goals for treatment and on coping styles were
related to better adjustment and more favorable impres-
sions of the sessions. In no case did a cognitive mismatch
predict better outcome. This study is important because
it demonstrates that therapists' conceptions and their con-
gruence with those of clients are related to therapeutic
outcomes. An additional finding is that within-group dif-
ferences were associated with acculturation levels of cli-
ents and therapists. Whereas our previous studies (S. Sue
et al., 1991; Takeuchi et al., 1995) showed that ethnic
match is important, we now have additional knowledge
about the conditions that are related to favorable out-
comes within ethnic match, that is, cognitive match.
The findings from this research should not be very
surprising. As noted earlier, a number of investigators
have argued that ethnic match and cognitive match are
important. The significant point is that now there is em-
pirical support for these arguments. The findings also
suggest that there is a need to increase the ethnic diversity
of service providers and to train therapists to understand
the worldviews of their clients. Obviously, if clients' cul-
tural beliefs radically differ from those of their therapists,
rapport in treatment and treatment outcomes may be
affected.
Dilemmas in Cultural Competence Research
In my search for cultural competency, I have been con-
fronted with several dilemmas (S. Sue, 1992, 1995). The
dilemmas are important to reveal because they illustrate
the problems and misunderstandings that arise in ethnic-
racial research. I review some of them and address the
implications for policy and practice.
First, in psychology, there is growing interest in
basing interventions on findings from rigorously con-
ducted, empirical research because the practice of psy-
chology has proceeded with insufficient guidance from
or adherence to research findings (Dawes, 1995). Yet,
in the case of ethnic minority populations, no rigorous
research has determined if psychotherapy is effective. If
therapists need to base practice on research findings, and
if psychotherapy and assessment tools have not demon-
strated their effectiveness or validity, should psychother-
apy continue to be offered to these populations? How
can guidelines and standards for cultural competency be
devised in the absence of research? I believe that service
providers must continue offering professional services to
ethnic populations and use therapists' best and collective
judgment in organizing services. There is substantial evi-
dence that mental health needs among ethnic minority
populations are substantial (Aponte & Crouch, 1995;
President's Commission on Mental Health, 1978), and
the mental health profession simply cannot wait for re-
search to provide definitive answers. Similarly, one of
the significant questions to address is why more research
and more rigorous research has not been conducted on
ethnic minority populations.
Second, the issue of segregation has been raised in
some of my work. In the past, I recommended that specific
services be created, targeting ethnic minority populations.
This recommendation seemed to make sense because in
communities with large ethnic populations, mental health
services should focus on these populations by tailoring
services--having bilingual-bicultural service providers,
a culturally familiar environment, notices and announce-
ments written in the ethnic language of the clients, and
so on. Would having ethnic-specific services encourage
segregation in that various ethnic groups would have ser-
vices catering to their own group needs? Kramer (1984)
opposed ethnic-specific services precisely because of his
belief that segregation would be perpetuated. Would this
relieve the responsibility for mainstream services (i.e.,
those not specifically designed for an ethnic minority
group) to provide for ethnic minority groups? In principle,
I agreed with the need for integrated services. However,
at the time, integration of services did not seem likely in
the near future because of ethnic patterns of residential
segregation. Furthermore, the tailoring of services to par-
ticular ethnic groups appeared to be wise because these
groups have been underserved or inappropriately served
in the mental health system (President's Commission on
Mental Health, 1978; Rogler, Malgady, & Rodriguez,
1989). This tailoring was not intended to relieve main-
stream services from providing services to ethnic clients;
rather, it was meant to complement existing services.
Third, ethnic matching of therapists and clients has
also raised the issue of segregation. As mentioned earlier,
my research (S. Sue et al., 1991) examined the effects
of ethnic similarity-dissimilarity between clients and
therapists in psychotherapy. The research findings indi-
cated that African American, American Indian, Asian
American, Mexican American, and White clients had
lower premature termination rates, a greater number of
sessions, or better treatment outcomes when matched
with ethnically similar therapists. I suggested that ethnic
similarity is beneficial for many clients and that the re-
cruitment and training of therapists to serve their own
ethnic populations should be encouraged. This suggestion
proved to be a source of controversy. During a talk I
gave at the 1994 Congress meeting of the International
Association of Applied Psychology in Spain (S. Sue,
1994), a member of the audience informed me that some
individuals in South Africa were using my research to
justify segregation, that is, having Whites taking care of
Whites and Blacks taking care of Blacks.
Although researchers often bemoan the fact that
their research is not used for applied purposes or policies,
my colleagues and I had the very opposite reaction. The
April 1998 American Psychologist 443
research was used. Advocates of certain policy agendas
used our research findings in ways that we never antici-
pated. The research findings were not intended to be used
to argue that clients should be ethnically matched. Rather,
we wanted to find out if ethnic matching was associated
with positive outcomes. We would then be in a position to
examine what about match could account for the findings.
Furthermore, individual differences in the effects of
match appear to be very important, so that match is nei-
ther a necessary nor a sufficient condition for positive
treatment outcomes. In other words, match may be im-
portant for some, but not all, clients. Ethnic diversity
among service providers was essential because it allowed
clients from minority groups the choice to find providers
of the same ethnicity.
Fourth, another example of how ethnic mental health
research has been used for purposes unanticipated by my
colleagues and me occurred from some earlier work (S.
Sue, 1977) that we conducted from data supplied by the
state of Washington. In that National Institute of Mental
Health (NIMH)-funded research project, we wanted to
see
how ethnic minority clients were faring in the mental
health system. We found that more than 50% of the ethnic
minority clients (African Americans, American Indians,
Asian Americans, and Mexican Americans) at the 17
community mental health facilities in Seattle-King
County terminated treatment after one session, compared
with the 30% dropout rate for Whites. We concluded that
ethnic clients were not being well served by the system.
Unknown to us, when NIMH became aware of our find-
ings, it contacted the Washington State Department of
Social and Health Services (DSHS) to express its deep
concern over the plight of ethnic minority mental health
clients. NIMH essentially used our findings to point out
that the state was not in compliance with standards to
provide quality services to all groups. Fearing that the
state might suffer adverse public reaction because of the
study's results and that future funding from NIMH might
be jeopardized, DSHS then challenged the validity of our
findings. It claimed that 1 of the 17 mental health centers,
which contained a high proportion of ethnic clients,
might not have provided valid data.
We decided to reanalyze the data, excluding the one
mental health center in question. The findings remained
the same. Yet, we were not happy over the situation for
several reasons. First, we felt torn between the need to
understand the nature of the problems in our mental health
system (which would enable us to find means for resolving
these problems) and the need to commend the state for its
openness and support for the research. Second, we and
the state did not know that the research would be used
for compliance purposes; I was worried that in the future
local and state governmental agencies might be reluctant
to provide data to researchers for fear that the findings
might have negative consequences for the agencies. Third,
although I was pleased with the fact that NIMH demon-
strated a determination to see that all clients are able to
receive effective treatment, I was also concerned that the
state of Washington was being singled out for criticism
when other states were experiencing similar difficulties in
the provision of services to ethnic clients. Because of the
controversy, I was asked by the Washington State Psycho-
logical Association to testify at a Senate subcommittee
hearing concerning the entire matter. Fortunately, some
positive outcomes emerged after my testimony. Officials
from the state indicated their genuine concern over the
delivery of services to all clients and their willingness to
collaborate on research in the future. In addition, over the
years, the state made some innovative changes in the men-
tal health system to offer culturally responsive services.
In a 10-year follow-up investigation of the Seattle project,
O'Sullivan, Peterson, Cox, and Kirkeby (1989) found that
the high dropout rates for ethnic minority clients had been
reduced and that the mental health system had hired more
ethnic minority service providers, created more ethnic-
specific services, and established other programs to
serve
ethnic clients.
Fifth, S. Sue et al.'s (1991) study demonstrated that
dropout rates are reduced and the number of treatment
sessions is increased when clients see ethnically similar
therapists. However, given managed care guidelines, in
which short-term treatment is preferred, what will these
findings mean? That is, because ethnic similarity between
clients and therapists is associated with longer treatment,
under managed care ethnic similarity may pose problems,
for example, the greater the number of sessions, the cost-
lier the treatment. Therefore, the association between eth-
nic match and increased number of treatment sessions
can be used to argue against matching because match
appears to increase the cost of treatment. This is a particu-
lar problem because superior outcomes for ethnically
matched dyads could not be unequivocally demonstrated
from the match studies.
Lessons Learned From the Research
What lessons have been learned? The dilemmas that have
accompanied the work illustrate the possibility that in
conducting ethnic research, investigators are likely to en-
counter the issues and conflicts that have bedeviled U.S.
society with respect to ethnic and race relations. That is,
race relations have always generated considerable emo-
tional reactions. Research into these issues will also en-
gender many emotional responses. The emotional inten-
sity in debates over ethnic research findings is typically
much greater than that found in debates over, for example,
depression research. This intensity is understandable.
Many of the findings from ethnic research have implica-
tions for policies and practices and can support or chal-
lenge cherished personal values and beliefs. In this sense,
ethnic minority research can be distinguished from cross-
cultural research. In comparative cross-cultural research,
evaluations and contrasts are made of people in different
cultures (e.g., Chinese in China and Mexicans in Mex-
ico). In comparative ethnic minority research, the evalua-
tions and contrasts typically involve not only people with
different cultural backgrounds but also those who have
had years of interactions (e.g., African Americans and
White Americans). Therefore, unlike cross-cultural re-
444 April 1998 American Psychologist
search, ethnic minority research must take into account
the history of race-ethnic relations, prejudice, stereotyp-
ing, and discrimination, in addition to cultural differences
(Jones, 1997; Watts, 1994). It is this history that makes
ethnic minority research a volatile area of investigation.
Partly as a consequence of the potentially controver-
sial nature of ethnic research or the practical, method-
ological, and conceptual problems in such research, in-
vestigators may be reluctant to study ethnicity. This is
unfortunate because ethnic research is beneficial not only
for ethnic individuals but also for all Americans and for
science. As a case in point, having served on the APA
Division 12 Task Force on Psychological Interventions,
I sincerely appreciated the efforts to determine which
treatments have empirical validation. However, as men-
tioned earlier, no rigorous studies have ever been con-
ducted on the efficacy of treatment for members of ethnic
minority groups. Why is there a paucity of research on
the effectiveness of treatment with different client popula-
tions? How can treatments be designated as validated
(i.e., where validity is attributed to the treatments) when
cross-cultural-ethnic minority validity has never been
established? In other words, it is precisely through the
study of different populations that the validity and appli-
cability of theories and practices can be ascertained.
Finally, in acknowledging the difficulties and dilem-
mas that are faced in ethnic research, psychology should
be prepared to deal with the issues. The complexity of
issues must be recognized, especially when research on
ethnicity often has policy, practice, and value implica-
tions. Many actions that are based on research have in-
tended or unintended side effects, so that practices may
be beneficial at one level but harmful at another level.
For example, ethnic match of therapists and clients can be
viewed as either positive (i.e., reducing treatment dropout
rates and increasing the number of treatment sessions) or
negative (i.e., driving up the cost of treatment because
of the increased number of sessions). Psychologists must
begin to anticipate the consequences of research and
practices because it may not be possible to avoid the side
effects of programs and policies that are undertaken. In
this way, conscious and deliberate decision making can
be made that considers costs, benefits, principles, reali-
ties, values, and ultimate goals in a multiethnic society.
It is through this process of deliberation that a more
coherent approach to diversity can emerge.
Researchers have made progress on determining the
nature of cultural competency. Empirical research does
support some of the arguments that ethnic researchers
and practitioners have advanced over the years. However,
findings have frequently raised controversies, and re-
searchers must be aware of the implications of their work,
including misuse of the findings. Many of the controver-
sies reveal society's discomfort regarding issues of race
and ethnicity.
Cultural Competency Ingredients
Research has provided some insights into the structural
ingredients (ethnic, service, and cognitive match) that are
associated with treatment outcomes. I now return to the
basic issue of what cultural competence is. The simple
definition is that cultural competence involves effective-
ness in psychotherapy. However, what therapist character-
istics or skills are important? Research has not provided
much knowledge into this question or many other ques-
tions. If a person is culturally effective with one group,
is that person a culturally competent therapist? Or does
culturally competent mean that one is effective with more
than one culturally distinct group? If one of the character-
istics of cultural competency is knowing the cultures of
groups, and if it is impossible to really know the cultures
of all groups in society, can one ever be truly culturally
competent?
Perhaps the reason for the existence of these ques-
tions is that investigators have not in a clear fashion
conceptually distinguished between general skills that
promote cultural competency and specific skills that en-
hance effectiveness in a particular culture. For example,
just as a psychotherapist may be limited in effectively
applying Western-based treatments to individuals from
non-Western societies, a folk healer who is effective in his
or her culture may be ineffective with people in Western
cultures. There appear to be skills that enhance work
across different cultural groups and skills that may be
specific to particular groups. This is why researchers have
had a very difficult time devising measures of cultural
competency--because culture-specific skills rather than
more general skills may be assessed, or visa versa. Gen-
eral and specific skills need to be considered.
I would like to advance several propositions in try-
ing to uncover the essence of cultural competency. First,
three characteristics are critical in cultural competency:
(a) being scientifically minded, (b) having skills in dy-
namic sizing, and (c) being proficient with a particular
cultural group. Second, these characteristics are orthogo-
nal in that it is possible to be proficient in none, one,
two, or all of them. Third, there are degrees of cultural
competency, and to adequately measure it, all three char-
acteristics must be considered.
Scientific Mindedness
There probably are some skills that are beneficial to have
in cultural competency--characteristics or skills that cut
across cultures. Although examples can be found where
some time-honored skills, such an being an empathic
therapist or a good listener, may not be culturally appro-
priate, on the whole, there are some characteristics that
are important to possess.
I believe one of these characteristics is scientific
mindedness. By scientific mindedness, I am referring to
therapists who form hypotheses rather than make prema-
ture conclusions about the status of culturally different
clients, who develop creative ways to test hypotheses,
and who act on the basis of acquired data. In cross-
cultural relationships, many mistakes happen because as-
sumptions are made or theories are applied that are devel-
oped in one culture and applied to clients from different
cultures. The assumptions are based on erroneous beliefs
April 1998 American Psychologist 445
that clients' processes or dynamics are the same across
different cultures, a phenomenon labeled the "myth of
sameness" (Wilson, Phillip, Kohn, & Currey-E1, 1995).
By forming hypotheses rather than using the sameness
myth, therapists can then test their clinical inferences.
For example, a client who reports seeing spirits may be
experiencing a common cultural hallucination rather than
a psychotic episode. A good clinician who is uncertain
of the cultural meaning of the symptom should engage
in hypothesis testing: For example, if the symptom is a
reflection of a psychotic episode rather than a culturally
influenced characteristic, one would expect (a) the client
to manifest other psychotic symptoms, (b) other individu-
als in the culture to be unfamiliar with the symptom, or
(c) experts in the culture to indicate that the symptom is
unusual in that culture. Ridley (1995) noted that African
American clients exhibiting paranoia in the presence of
a therapist may be doing so because of a healthy or
unhealthy condition. Because of experiences with racism,
those who show discomfort and lack of self-disclosure
with a White therapist may have a nonpathological reac-
tion (cultural paranoia). In this case,Ridley hypothesized
that the reaction is confined to a White therapist and not
an African American therapist. A pathological condition
is functional paranoia, in which self-disclosure is not
made to any therapist regardless of race. The point is that
culturally competent therapists will try to devise means
of testing hypotheses about their clients. This scientific
mindedness may also help to free therapists from ethno-
centric biases or theories.
Dynam& Sizing
The second characteristic is dynamic sizing--a phrase
used in computer circles to indicate a fluctuating cache
size. I use it to mean that the therapist has appropriate
skills in knowing when to generalize and be inclusive
and when to individualize and be exclusive. That is, the
therapist can flexibly generalize in a valid manner. One
of the major difficulties in interpersonal and interracial
or interethnic relationships is the stereotyping of mem-
bers of a group (Jones, 1997). Although therapists may
avoid the overt expression of stereotypes (e.g., beliefs
that African Americans are lazy, Chinese are shy, Mexi-
can Americans are family-oriented), stereotypes may,
nevertheless, exist in their belief systems and affect their
behaviors. In such stereotypes, the individual's character-
istics are confounded with the characteristics attributed
to the group. In contrast, the opposite mistake can be
made, such as ignoring cultural group characteristics that
may be affecting that individual. Prejudices, stereotypes,
and failures to consider culture among therapists or ser-
vice providers are frequently no different from those
found among the general population.
Appropriate dynamic sizing is a critical part of cul-
tural competency. It allows one to avoid stereotypes of
members of a group while still appreciating the impor-
tance of culture. The concept is similar to the notion of
"flex" proposed by Ramirez (1991). In flex, individuals
can learn how to switch cognitive styles (e.g., field depen-
dence and independence) to more accurately deal with
the environment. In dynamic sizing, the therapist is able
to place the client in a proper context--whether that
client has characteristics typical of, or idiosyncratic to,
the client's cultural group. Moreover, there is another
important component of dynamic sizing that involves the
ability to appropriately generalize one' s own experiences.
For example, a person who has experienced discrimina-
tion and prejudice as a member of one group may be
able to understand the plight of those in another group
who encounter the same experiences. An African Ameri-
can who has faced oppression may be able to more easily
understand the feelings of women who are oppressed. All
people have felt like outsiders at one time or another. If
this experience can be used to understand the feelings of
many minority group persons, then therapists can become
more empathetic and understanding and better clinicians.
They are able to see and understand common experiences.
However, the mere fact that therapists have experiences
as, for example, an outsider, does not guarantee the ability
to empathize. The ability to dynamically size--to appro-
priately categorize experiences--is important.
Culture-Specific Elements
The third characteristic is culture-specific expertise. Dif-
ferent cultures may have culture-specific experts--sha-
mans, witch doctors, fortune-tellers, acupuncturists, folk
healers, and so forth. These experts presumably are effec-
tive in their own cultures because they know the cultures
and have the skills to translate this knowledge into effec-
tive interventions. Culturally skilled helping profession-
als have good knowledge and understanding of their own
worldviews, have specific knowledge of the cultural
groups with which they work, understand sociopolitical
influences, and possess specific skills (intervention tech-
niques and strategies) needed in working with culturally
different groups. These helping professionals also are
able to use culturally based interventions and have the
ability to translate interventions into culturally consistent
strategies. These characteristics have been extensively
discussed in the literature as being important in effective
psychotherapy and counseling with members of minority
groups (see Chin, De La Cancela, & Jenkins, 1993;
Helms & Richardson, 1997; Lee, 1996; Paniagua, 1994;
Parham, 1996; Root, 1985; D. Sue et al., 1996).
The three characteristics--scientific mindedness,
dynamic sizing, and culture-specific expertise--are or-
thogonal. That is, the three are independent. It is possible
to be scientific minded and yet naive about the cultural
background of the client (i.e., have good general skills
but no knowledge of the culture of a particular client);
to be able to appropriately generalize and individualize
and yet fail to engage in hypothesis testing; and to under-
stand and work effectively in a particular culture and yet
use stereotypes of individuals in another culture.
Although it would be desirable to have the three
characteristics, most therapists vary in the degree to
which each characteristic is possessed. Scientific mind-
edness and dynamic sizing provide clinicians with gen-
446 April 1998 American Psychologist
eral tools that can be carried from one cultural client or
situation to another. They provide a modus operandi. For
example, using the skills associated with scientific mind-
edness, a clinician seeing a client from Culture X might
reflect as follows:
I am unfamiliar with Culture X. Therefore, in working with the
client, I first have to address a number of basic questions.
For example, how proficient is the client with English? How
acculturated is the client, and how familiar is the client with
psychotherapy? Will there be communication difficulties? How
will I assess the client? What does the client think of me and
of treatment? I next have to form hypotheses, test the hypothe-
ses, and then modify my behaviors in accordance with the
findings.
In dynamic sizing, the therapist treating the client
from Culture X might consider the following questions:
What are my stereotypes or impressions of the client and
the client's culture? How typical is the client of the cul-
ture? What might the client be thinking or feeling as
a member of that culture? As in the case of scientific
mindedness, dynamic sizing is a general tool that can be
applied from client to client. The tools force therapists
to systematically consider issues that therapists typically
ignore or erroneously assume to know the answers. They
can be used with all clients but are especially helpful
with those who come from cultures different than that of
the therapist.
When researchers try to measure cultural compe-
tence, they should not be confined just to the knowledge
that they have about a particular culture. Rather, research-
ers also have to assess general skills such as scientific
mindedness and dynamic-sizing abilities. I believe that
they are among the most important characteristics that
define cultural competency.
In summary, I have tried to reflect on experiences
that my colleagues and I have had in the search for cul-
tural competency. Our empirical research has largely sup-
ported the importance of phenomena that other research-
ers and professionals have proposed as being critical in
cultural competence, namely, ethnic match, service
match, and cognitive match. In following this line of
research, I have encountered many policy and political
issues that have made me aware of the need to constantly
indicate the meaning and limitations of my findings. In
the course of my research, I have come to the opinion
that three independent characteristics involving scientific
mindedness, dynamic sizing, and culture-specific exper-
tise are important in cultural competence.
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448 April 1998 American Psychologist
... The literature suggests a lack of measures for assessing multiple dimensions of cultural competency within the general population as conceptualized in the psychological literature (i.e., awareness, knowledge, skills) [4]. This may contribute to researchers relying on proxy measures of cultural competency in the general population such as colorblindness [32], empathy [33], and social dominance orientation [34]. ...
... Cultural competency is conceptualized and defined differently across fields. As we sought to develop the current scale to support psychologists in evaluating cultural competency in training and research we drew from the Sue's cultural competency model to develop ASK-G items, factors loadings (awareness, knowledge, skills), and while seeking expert feedback to form the final scale [4]. If the theorized three-factor loading fit the data poorly using a confirmatory approach, an exploratory analyses would be conducted to identify factors within the scale. ...
... We developed a general cultural competence measure based on the tripartite model from Sue's cultural competency model that can be used broadly across disciplines [4]. Many of the current empirically supported cultural competence measures are specific to practitioners or students and do not necessarily capture attitudes, knowledge, or skills relevant to interpersonal exchanges in the general population. ...
Article
Full-text available
Measuring cultural competence has been difficult for conceptual and practical reasons. Yet, professional guidelines and stated values call for training to improve cultural competence. To develop a strong evidence-base for training and improving cultural competence, professionals need reliable and valid measures to capture meaningful changes in cultural competence training. We developed a measure for cultural competence that could be used in a general population to measure changes in awareness, knowledge, and skills in interacting with culturally diverse others. We built an 81-item scale with items conceptually categorized into awareness, knowledge, and skills and was presented to an expert panel for feedback. For evaluation, a national panel of 204 adults responded to the new scale and other measures associated with cultural competence. Factor analysis revealed four factors with strong reliabilities: Awareness of Self, Awareness of Others, Proactive Skills Development, and Knowledge (as = .87-.92). The final overall scale, Awareness, Knowledge, Skills-General (ASK-G) had 37 items and strong reliability (a = .94). The ASK-G was then compared to validated scales to provide evidence of concurrent, convergent, and divergent validity. Strong evidence emerged for these. The ASK-G is a promising tool to measure cultural competence in a general population.
... Προκειμένου να αποφθεχθούν τέτοιου τύπου παρερμηνείες, οι οποίες προκύπτουν και από τις γενικότερες πολιτιστικές διαφορές αναφορικά με τον ορισμό για το τι είναι παθολογικό και τι φυσιολογικό, η διαπολιτιστική συμβουλευτική υποστηρίζει ότι μία βασική ικανότητα του συμβούλου θα πρέπει να είναι η «επιστημονική συνειδητότητα» (scientific mindedness). Σύμφωνα με την Sue (1998), η «επιστημονική συνειδητότητα» συνίσταται στην ικανότητα του θεραπευτή που ασχολείται με πολιτισμικά διαφοροποιημένα άτομα να διατυπώνει υποθέσεις αναφορικά με την ψυχολογική κατάσταση του πελάτη παρά να εξάγει πρώιμα συμπεράσματα, να μπορεί να ανακαλύπτει ευρηματικούς τρόπους δοκιμασίας αυτών των υποθέσεων και τέλος να μπορεί να αντιδρά στη βάση των στοιχείων που θα έχουν προκύψει από αυτές τις δοκιμασίες. Μέσω αυτής της διαδικασίας αποφεύγεται η αυθαίρετη επιβολή θεωρητικών απόψεων ή πεποιθήσεων που κυριαρχούν σε ένα συγκεκριμένο πολιτιστικό περιβάλλον σε πολιτισμικά διαφοροποιημένα άτομα με κίνδυνο οι ερμηνείες και οι διαγνώσεις που δίνονται να μην ανταποκρίνονται στην πραγματική κατάσταση του ατόμου. ...
... Κατά συνέπεια, προκειμένου ο θεραπευτής να μπορεί να «ενσυναισθάνεται πολιτισμικά» τους πελάτες του θα πρέπει να αποφεύγει την απόδοση στερεοτύπων σε αυτούς λόγω του ότι είναι μέλη μιας συγκεκριμένης φυλετικής ομάδας, παράλληλα όμως θα πρέπει να αναγνωρίζει τη σημασία των πολιτισμικών επιδράσεων στη συμπεριφορά τους. Με άλλα λόγια θα πρέπει, όπως αναφέρει η Sue (1998), να έχει την ικανότητα να κάνει ένα «δυναμικό ζύγιασμα» (dynamic sizing) του πολιτισμικά διαφοροποιημένου πελάτη του. ...
Article
Το συγκεκριμένο άρθρο επιχειρεί να διερευνήσει το ερώτημα: Πώς μπορεί η διαπολιτιστική συμβουλευτική και ψυχοθεραπεία να συμβάλλει στην κατάλληλη αντιμετώπιση των προσφύγων που ζουν στην Ελλάδα; Με βάση τη μέχρι τώρα εμπειρία σε χώρες όπου έχει ήδη εφαρμοστεί η διαπολιτιστική συμβουλευτική και σύμφωνα με τα δεδομένα που προκύπτουν και από την ελληνική εμπειρία γνωρίζουμε ότι οι πρόσφυγες έρχονται αντιμέτωποι με μια διττή πραγματικότητα: από τη μια πλευρά καλούνται να αντιμετωπίσουν τις μαζικές απώλειες της οικογένειας, του πολιτισμού, του προηγούμενου κοινωνικού πλαισίου αναφοράς, της επαγγελματικής και οικονομικής τους κατάστασης, και από την άλλη αντιμετωπίζουν καινούργιες απαιτήσεις για προσαρμογή. Σε συνδυασμό με αυτές τις δυσκολίες, η προσαρμογή και η ενσωμάτωση της συγκεκριμένης ομάδας επηρεάζεται και από τις πολιτισμικές διαφορές οι οποίες υπεισέρχονται στις διαπροσωπικές σχέσεις. Στο πλαίσιο αυτό, η διαπολιτιστική ψυχοθεραπεία φαίνεται να αποτελεί την πλέον κατάλληλη προσέγγιση για τους πρόσφυγες, αφού παρέχει τη δυνατότητα για μια ολιστική, πολύ-επίπεδη και ευέλικτη παρέμβαση η οποία λαμβάνει υπόψη τα ιδιοσυστασιακά χαρακτηριστικά του ατόμου, καθώς και τον ρόλο των πολιτισμικών επιρροών στη διαμόρφωση της ταυτότητάς του. Παράλληλα, η εφαρμογή της στην Ελλάδα φαίνεται να είναι απαραίτητη, αφού τόσο οι ανάγκες των προσφύγων στη χώρα όσο και οι δυσκολίες που προκύπτουν από τις πολιτισμικές διαφορές έχουν πολλά κοινά με τα θέματα που εξετάζει η διαπολιτιστική συμβουλευτική.
... Further complicating the clinician's task is the fact that there is often considerable withingroup cultural variation. Even though certain aspects of culture are commonly observed within particular groups, clinicians should not assume that all members of a community share those aspects equally (Ryder et al., 2011;Sue, 1998). Integrating culture into clinical assessment does not negate person-level characteristics and behaviors; rather, integrating cultural context enriches them with meaning. ...
... Assessments that fail to take cultural context into account can lead to further mental health disparities, especially for minority groups, who already face significant barriers accessing services (Chiu et al., 2018). Assessment mistakes can compromise rapport, leading not only to misdiagnosis but also to social implications such as the perpetuation of negative stereotypes based on group membership (Sue, 1998). Such unfounded assumptions can become normative beliefs held by individual practitioners and promoted through organizational networks. ...
Chapter
Accounting for cultural context in psychological assessment is a challenging endeavor, but one that is essential if the clinician is to provide accurate diagnoses and proceed with effective treatment plans. This chapter aims to provide some clarity to clinicians and researchers regarding how culture should be understood and addressed in assessment settings. A conceptual account is provided of how psychopathology is shaped by culture so that the reader gains an appreciation for the essential role that culture plays in the development, experience and expression of psychopathology. The negative consequences of not accounting for culture when conducting clinical assessments are then highlighted through selected examples. Practical recommendations are then provided concerning how to conduct a psychological assessment that accounts for culture. These recommendations include how to conduct a culturally-informed clinical interview, how to select valid and reliable measurement instruments and interpret their scores, and how to develop treatment plans that take patients' cultural contexts into account.
... This came about in part because of pressure from the US National Institute of Mental Health (NIMH)and from interest groups within the APA, reflecting the increasing ethnocultural diversity ofthe profession (7). Both the APA and the American Psychological Association have developed standards for cultural competence in professional training and quality assurance in service delivery (69). Initiatives at the level of both federal and state governments are addressing mental health service delivery issues for diverse populations (Note 2). ...
... In recent decades, multicultural perspectives have broadened in psychological research, and many understudied ethnic groups have begun to be represented (Heppner, 2006;Heppner et al., 2008;Inman et al., 2019;Nilsson et al., 2019;Wang & Çiftçi, 2019). Research indicates that traditional empirically supported treatments do not show the same efficacy in ethnic minority populations as they do with those of European descent (Matt & Navarro, 1997;Miranda, 1996;Sue, 1998Sue, , 1999. In light of these findings, researchers have sought to understand cultural nuances and norms in order to develop psychotherapies that align with the cultural contexts of ethnically diverse groups. ...
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The purpose of this study was to understand Polynesian American (PA) values, preferences, and beliefs about psychotherapy in light of their culture. An Interpretative Phenomenological Analysis (IPA) was conducted to collect and analyze culturally relevant preferences and expectations of psychotherapy with Polynesian Americans. The study consisted of 13 in-depth interviews with individuals of Pacific Islander descent who are currently living in the United States. The results of the analysis showed three culturally informed themes shared by study participants that informed this sample’s expectations and preferences of psychotherapy: ʻOhana (family), Lōkahi (harmony) and Aloha (warmth, compassion, love). These values provide unique insights to therapy adaptations that should be emphasized when working with Polynesian American clients, such as using a family centered approach to therapy that takes into account the collective needs of a client’s entire family, participating in therapist self-disclosure and the sharing of personal backgrounds, looking at clients challenges through a holistic lens, and demonstrating genuine warmth in the client-counsellor relationship. We discuss clinical implications and recommendations for Polynesian Americans in future research.
... Over the past several decades, the literature has continued to promote systemic modifications to treatment across mental health disciplines so that approaches are inclusive and applicable for racial and ethnic minority populations (e.g., Bernal & Sáez-Santiago, 2006;Griner & Smith, 2006;Stevenson, 1994;Sue, 1998). Prevention programs have been developed that include African American and Latinx children and families, some via home-visiting models and others via family groups (Olds, 2002;Smith et al., 2004). ...
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Children and families of color in the United States (U.S.) have long had to battle to develop a positive identity in the face of discrimination based upon race, ethnicity, immigration status, and gender. Historically, racial-ethnic minorities have experienced various types of trauma exposures in the U.S., including enslavement, family separation, deportation, colonization, discrimination, ridicule, and stereotyping that permeate U.S. society. Yet, they still have managed within their families to advance some sense of shared within-group identities, values, beliefs, and practices that have fostered child and family development. This paper focuses on the experiences of African American and Latinx families who, though distinct in historical and cultural experiences, have some similarities in social disparities that should inform parenting programs. Prevention and intervention that seeks to engage families of color should be sensitive to centuries of racism and structural inequalities that have contributed to their unique socio-cultural contexts (Bernal et al., 2009; Spencer et al., 1997). We first explore the historical context of racial-ethnic trauma among children of color in the U.S. Second, we build upon the work in traumatic stress as a rationale for examining culturally relevant and responsive adaptations that address linguistics, worldviews, and contexts, describing the ways in which these concepts are evidenced in programming and effects upon family processes, and youth socio-emotional development. We discuss the implications for multi-group intervention, homogenous and heterogeneous group composition, underscoring the value of critical frameworks attuned to psychological trauma that draw upon a strengths-based perspective of culture for African American and Latinx children and families.
... Cultural competence has been defined as a set of congruent behaviours, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations (Stuart 2004). Psychotherapists' self-awareness of their own culture, their knowledge of minority cultures and their cross-cultural skills pertaining to work with BAME populations are some of the factors that influence the provision of culturally competent services (Sue 1998). According to Sue et al. (2009), the culturally competent psychological therapist has the characteristics presented below. ...
Thesis
Background: England has a multicultural society and so, health professionals will engage with clients from culturally and racially diverse backgrounds. Research suggests that psychological therapists are not adequately prepared or trained to practice cross-culturally, even though multicultural competence is recognised as a key component of mental health policy and professional codes of conduct. In particular, research is lacking on how psychological therapists experience cross-cultural practice in an unlike racial and cultural dyad. Study aims: The aims of the present research were to explore and understand psychological therapists’ lived experience of cross-cultural practice, and to identify the successful elements as well as the difficulties of cross-cultural therapeutic work. Design: Seven practising psychological therapists (four White British and three African-Caribbean) were interviewed about their cross-cultural work using a semi-structured format. Their accounts were analysed using Interpretative Phenomenological Analysis (IPA). Findings: Four themes were identified: (1) The mastering cross-cultural/racial practice; (2) barriers to effective cross-cultural/racial work; (3) cross-cultural/racial learning in practice; (4) supervision/support as a “potential” site for cross-cultural fertilisation. These four themes culminate in the overall finding that: participants felt unprepared and inadequately trained to practice cross-culturally, but over time and with ongoing training and supervision, their experiences shifted progressively to mastery of a range of culturally competent skills. The findings, while supporting previous cross-cultural therapeutic work literature, have also clarified complex and important issues regarding training and supervision. Recommendations: Within psychological therapeutic cross-cultural work, the initial and ongoing training, learning and supervision of therapists should foster experiential learning and encourage mindful exploration of own racial biases and identity, encouraging personal and professional self-exploration at both individual and group levels. Cross-cultural reflective practice, collaborative practice and group supervision are seen as a means to reinforce and nurture therapists’ willingness to transform and competently adapt their cross-cultural therapeutic work as required. The innovation of a Cultural Formulation and Supervision Group (CFSG) is proposed as an alternative to mitigate the challenges associated with current one-to-one models of supervision and offers an environment where professionals can willingly and safely discuss difficult situations, self-explore and learn new approaches and skills in a non-judgmental and safe environment.
... Ένα πλαίσιο διαπολιτισμικής ικανότητας από την πλευρά του Δασκάλου-Συμβούλου, περιγράφεται από τους (Sue, 1998, Pedersen,2002 και αφορά : ...
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Στόχος αυτού του κεφαλαίου είναι η σύνδεση της Συμβουλευτικής Ψυχολογίας με το κίνημα του πολυπολιτισμού και της αποδοχής της διαφορετικότητας. Η βασική θέση είναι ότι η Συμβουλευτική Ψυχολογία αποτέλεσε -και συνεχίζει να αποτελεί- τον φυσικό ιδεολογικό χώρο, την κοίτη ανάπτυξης του κινήματος του πολυπολιτισμού και της αποδοχής της διαφορετικότητας και κατά συνέπεια ότι η σχέση της Συμβουλευτικής Ψυχολογίας με το κίνημα του πολυπολιτισμού είναι σχέση «γονέα – παιδιού» μιας και είναι η Συμβουλευτική Ψυχολογία αυτή που συνέβαλε σε μέγιστο βαθμό, μέσα από το χώρο της Ψυχολογίας, στη γενική αποδοχή και στο σεβασμό των πολιτισμικών και ατομικών χαρακτηριστικών και διαφορών. Στο πρώτο μέρος του κεφαλαίου παρουσιάζεται η ανάπτυξη της Συμβουλευτικής Ψυχολογίας, οι θεωρητικές και οι ιδεολογικές της βάσεις και η ταυτότητα της έτσι όπως αυτή διαμορφώθηκε κυρίως στη Βόρεια Αμερική από όπου και γεννήθηκε. Μέσα από αυτή την παρουσίαση καταδεικνύεται ότι το πολυπολιτισμικό κίνημα γεννήθηκε, αναπτύχθηκε και στηρίζεται σε κοινές αρχές με αυτές της Συμβουλευτικής Ψυχολογίας, και κατά συνέπεια ότι οι Συμβουλευτικοί Ψυχολόγοι αποτελούν par excellence τους πρεσβευτές και τους φυσικούς εκπρόσωπους στο χώρο της ψυχικής υγείας του πολυπολιτισμικού κινήματος. Στο δεύτερο μέρος του κεφαλαίου παρουσιάζονται οι βασικές αρχές και παράμετροι του πολυπολιτισμικού κινήματος και τέλος αναφέρονται συνοπτικά οι απαραίτητες δεξιότητες και στάση του Συμβουλευτικού Ψυχολόγου που παρέχει συμβουλευτική σε άτομα από διαφορετικά πολιτισμικά πλαίσια.
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Examined differences between ethnic-specific and mainstream outpatient mental health services for Asian-American children. The study found that Asian-American children who received services at ethnic-specific centers were less likely to drop out of services after the first session, utilized more services, and had higher functioning scores at discharge than did those who attended mainstream centers, even when variables including social class and functioning score at admission were controlled. Centers were also compared on population characteristics and therapist-client ethnicity match. The findings suggest that ethnic-specific mental health centers are effective in sewing the Asian-American child community.