Friend or Foe: Empirically Supported Treatments for Culturally Minority Clients



Minority clients still experience mental health disparities due to barriers in accessing and receiving quality mental health treatments. Research shows that empirically supported treatments (EST) may not be as effective for minority populations. Culturally adapted interventions have shown positive results in decreasing mental health symptoms. However, it is unclear how cultural factors should be included in mental health treatments. This chapter summarizes existing literature on cultural factors (e.g., racial and ethnic match, cultural identity, face concerns) and how they influence treatment processes and outcomes. The proximal-distal model is proposed as a promising framework to guide interventions to be more culturally relevant, and to help clinicians identify potential barriers for their minority clients and adapt treatment for their specific needs.


Culture Ethnic minority clients Empirically supported treatment Mental health disparities Culturally adapted interventions 


  1. American Psychological Association. (2005). Policy statement on evidence-based practice in psychology. Retrieved from:
  2. American Psychological Association. (2018). Demographics of the U.S. psychology workforce: Findings from the 2007–16 American Community Survey. Washington, DC: Author.Google Scholar
  3. Arkoff, A. (1959). Need patterns in two generations of Japanese Americans in Hawaii. The Journal of Social Psychology, 50(1), 75–79.CrossRefGoogle Scholar
  4. Ayalon, L., & Young, M. A. (2005). Racial group differences in help-seeking behaviors. The Journal of Social Psychology, 145(4), 391–404.PubMedCrossRefGoogle Scholar
  5. Berger, L., Huang, C. Y., & Zane, N. W. (in press). Integrating approaches to advance research on culturally informed evidence-based tCabraleatments for Asian Americans. In F. Leong & G. Bernal (Eds.), Clinical psychology of ethnic minorities: Integrating research and practice.Google Scholar
  6. Bernal, G., & Rodríguez, M. M. D. (2012). Cultural adaptations: Tools for evidence-based practice with diverse populations. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  7. Cabral, R. R., & Smith, T. B. (2011). Racial/ethnic matching of clients and therapists in mental health services: A meta-analytic review of preferences, perceptions, and outcomes. Journal of Counseling Psychology, 58(4), 537–554.Google Scholar
  8. Cook, B. L., Hou, S. S. Y., Lee-Tauler, S. Y., Progovac, A. M., Samson, F., & Sanchez, M. J. (2018). A review of mental health and mental health care disparities research: 2011–2014. Medical Care Research and Review, 00(0), 1–28.Google Scholar
  9. Delphin-Rittmon, M. E., Flanagan, E. H., Andres-Hyman, R., Ortiz, J., Amer, M. M., & Davidson, L. (2015). Racial-ethnic differences in access, diagnosis, and outcomes in public-sector inpatient mental health treatment. Psychological Services, 12(2), 158–166.PubMedCrossRefGoogle Scholar
  10. Domenech Rodríguez, M. M., Baumann, A. A., & Schwartz, A. L. (2011). Cultural adaptation of an evidence-based intervention: From theory to practice in a Latino/a community context. American Journal of Community Psychology, 47(1–2), 170–186.PubMedCrossRefGoogle Scholar
  11. Flaskerud, J. H. (1986). Diagnostic and treatment differences among five ethnic groups. Psychological Reports, 58(1), 219–235.PubMedCrossRefGoogle Scholar
  12. Gary, F. A. (2005). Stigma: Barrier to mental health care among ethnic minorities. Issues in Mental Health Nursing, 26(10), 979–999.PubMedCrossRefPubMedCentralGoogle Scholar
  13. Georgiades, K., Paksarian, D., Rudolph, K. E., & Merikangas, K. R. (2018). Prevalence of mental disorder and service use by immigrant generation and race/ethnicity among US adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 57(4), 280–287.CrossRefGoogle Scholar
  14. Griner, D., & Smith, T. B. (2006). Culturally adapted mental health intervention: A meta-analytic review. Psychotherapy: Theory, Research, Practice, Training, 43(4), 531–548.CrossRefGoogle Scholar
  15. Guarnaccia, P. J., Lewis-Fernández, R., & Marano, M. R. (2003). Toward a Puerto Rican popular nosology: nervios and ataque de nervios. Culture, Medicine and Psychiatry, 27(3), 339–366.PubMedCrossRefPubMedCentralGoogle Scholar
  16. Hall, G. C. N., Ibaraki, A. Y., Huang, E. R., Marti, C. N., & Stice, E. (2016). A meta-analysis of cultural adaptations of psychological interventions. Behavior Therapy, 47(6), 993–1014.PubMedPubMedCentralCrossRefGoogle Scholar
  17. Helms, J. E. (2015). An examination of the evidence in culturally adapted evidence-based or empirically supported interventions. Transcultural Psychiatry, 52(2), 174–197.PubMedCrossRefPubMedCentralGoogle Scholar
  18. Huang, C. Y., & Zane, N. (2016). Cultural influences in mental health treatment. Current Opinion in Psychology, 8, 131–136.PubMedCrossRefPubMedCentralGoogle Scholar
  19. Huey, S. J., & Polo, A. J. (2008). Evidence-based psychosocial treatments for ethnic minority youth. Journal of Clinical Child & Adolescent Psychology, 37(1), 262–301.CrossRefGoogle Scholar
  20. Hwang, W. (2006). The psychotherapy adaptation and modification framework: Application to Asian Americans. American Psychologist, 61, 702–715.PubMedCrossRefPubMedCentralGoogle Scholar
  21. Hwang, W. C., Myers, H. F., Abe-Kim, J., & Ting, J. Y. (2008). A conceptual paradigm for understanding culture’s impact on mental health: The cultural influences on mental health (CIMH) model. Clinical Psychology Review, 28(2), 211–227.PubMedCrossRefPubMedCentralGoogle Scholar
  22. Iwamasa, G. Y., Hsia, C., & Hinton, D. (2006). Cognitive-behavioral therapy with Asian Americans. In P. A. Hays & G. Y. Iwamasa (Eds.), Culturally responsive cognitive-behavioral therapy: Assessment, practice, and supervision (pp. 117–140). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  23. Jackson, K. F. (2009). Building cultural competence: A systematic evaluation of the effectiveness of culturally sensitive interventions with ethnic minority youth. Children and Youth Services Review, 31(11), 1192–1198.CrossRefGoogle Scholar
  24. Kazdin, A. E., & Wilcoxon, L. A. (1976). Systematic desensitization and nonspecific treatment effects: A methodological evaluation. Psychological Bulletin, 83(5), 729–758.PubMedCrossRefGoogle Scholar
  25. Kazdin, A. E. (1977). Assessing the clinical or applied importance of behavior change through social validation. Behavior Modification, 1(4), 427–452.CrossRefGoogle Scholar
  26. Kim, H. S., Sherman, D. K., & Taylor, S. E. (2008). Culture and social support. American Psychologist, 63(3), 518–526.PubMedCrossRefGoogle Scholar
  27. Kim, J., & Zane, N. (2016). Help-seeking intentions among Asian American and white American students in psychological distress: Application of the health belief model. Cultural Diversity and Ethnic Minority Psychology, 22(3), 311–321. Scholar
  28. Kim, J. E., Zane, N. W., & Blozis, S. A. (2012). Client predictors of short-term psychotherapy outcomes among Asian and white American outpatients. Journal of Clinical Psychology, 68(12), 1287–1302.PubMedPubMedCentralCrossRefGoogle Scholar
  29. Lam, A. G., & Zane, N. W. (2004). Ethnic differences in coping with interpersonal stressors: A test of self-construals as cultural mediators. Journal of Cross-Cultural Psychology, 35(4), 446–459.CrossRefGoogle Scholar
  30. Lin, K. M., & Cheung, F. (1999). Mental health issues for Asian Americans. Psychiatric Services, 50(6), 774–780.PubMedCrossRefGoogle Scholar
  31. Lu, Y. E., Organista, K. C., Manzo, S., Jr., Wong, L., & Phung, J. (2001). Exploring dimensions of culturally sensitive clinical styles with Latinos. Journal of Ethnic and Cultural Diversity in Social Work, 10(2), 45–66.CrossRefGoogle Scholar
  32. Maramba, G. G., & Nagayama Hall, G. C. (2002). Meta-analyses of ethnic match as a predictor of dropout, utilization, and level of functioning. Cultural Diversity and Ethnic Minority Psychology, 8(3), 290–297.PubMedCrossRefPubMedCentralGoogle Scholar
  33. Markus, H. R., & Kitayama, S. (1991). Culture and the self: Implications for cognition, emotion, and motivation. Psychological Review, 98(2), 224–253.CrossRefGoogle Scholar
  34. McGee, S. A., & Claudio, L. (2018). Nativity as a determinant of health disparities among children. Journal of Immigrant and Minority Health, 20, 517–528.PubMedPubMedCentralCrossRefGoogle Scholar
  35. McGuire, T. G., Alegria, M., Cook, B. L., Wells, K. B., & Zaslavsky, A. M. (2006). Implementing the Institute of Medicine definition of disparities: An application to mental health care. Health Services Research, 41(5), 1979–2005.PubMedPubMedCentralCrossRefGoogle Scholar
  36. Meredith, G. M. (1966). Amae and acculturation among Japanese-American college students in Hawaii. Journal of Social Psychology, 70, 171–180.PubMedCrossRefGoogle Scholar
  37. Meyer, O. L., & Zane, N. (2013). The influence of race and ethnicity in clients’ experiences of mental health treatment. Journal of Community Psychology, 41, 884–901.Google Scholar
  38. Murase, T., & Johnson, F. (1974). Naikan, Morita, and Western psychotherapy: A comparison. Archives of General Psychiatry, 31(1), 121–128.PubMedCrossRefPubMedCentralGoogle Scholar
  39. Park, S., Kim, J., & Zane, N. (2019). Effects of ethnicity, counseling expectations, and face concern on counseling style credibility and the working alliance. Manuscript submitted for publication.Google Scholar
  40. Perez, J. E. (1999). Integration of cognitive-behavioral and interpersonal therapies for Latinos: An argument for technical eclecticism. Journal of Contemporary Psychotherapy, 29(3), 169–183.CrossRefGoogle Scholar
  41. Reimers, T. M., & Wacker, D. P. (1988). Parents’ ratings of the acceptability of behavioral treatment recommendations made in an outpatient clinic: A preliminary analysis of the influence of treatment effectiveness. Behavioral Disorders, 14(1), 7–15.CrossRefGoogle Scholar
  42. Sackett, D. L., Straus, S. E., Richardson, W. S., Rosenberg, W., & Haynes, R. B. (2000). Evidence based medicine: How to practice and teach EBM (2nd ed.). London, England: Churchill Livingstone.Google Scholar
  43. Shon, S. P., & Ja, D. Y. (1982). Asian families. In M. McGoldrick, J. K. Pearce, & J. Giordano (Eds.), Ethnicity and family therapy. New York, NY: Guilford Press.Google Scholar
  44. Snowden, L. R. (2001). Barriers to effective mental health services for African Americans. Mental Health Services Research, 3(4), 181–187.PubMedCrossRefPubMedCentralGoogle Scholar
  45. Spielmans, G. I., & Flückiger, C. (2018). Moderators in psychotherapy meta-analysis. Psychotherapy Research, 28(3), 333–346.Google Scholar
  46. Spring, B. (2007). Evidence-based practice in clinical psychology: What it is, why it matters; what you need to know. Journal of Clinical Psychology, 63(7), 611–631.PubMedCrossRefGoogle Scholar
  47. Stiffman, A. R., Pescosolido, B., & Cabassa, L. J. (2004). Building a model to understand youth service access: The gateway provider model. Mental Health Services Research, 6(4), 189–198.PubMedPubMedCentralCrossRefGoogle Scholar
  48. Sue, S. (1977). Community mental health services to minority groups: Some optimism, some pessimism. American Psychologist, 32, 616–624.PubMedCrossRefPubMedCentralGoogle Scholar
  49. Sue, S., Fujino, D. C., Hu, L.-t., Takeuchi, D. T., & Zane, N. W. S. (1991). Community mental health services for ethnic minority groups: A test of the cultural responsiveness hypothesis. Journal of Consulting and Clinical Psychology, 59(4), 533–540.PubMedCrossRefPubMedCentralGoogle Scholar
  50. Sue, S., & Morishima, J. K. (1982). The mental health of Asian Americans. San Francisco, CA: Jossey-Bass.Google Scholar
  51. Sue, S., & Zane, N. (1987). The role of culture and cultural techniques in psychotherapy: A critique and reformulation. American Psychologist, 42(1), 37–45.PubMedCrossRefPubMedCentralGoogle Scholar
  52. The California Evidence-Based Clearinghouse for Child Welfare (2007, October). The scientific rating scale. Retrieved from:
  53. Thompson, V. L. S., & Alexander, H. (2006). Therapists’ race and African American clients’ reactions to therapy. Psychotherapy: Theory, Research, Practice, Training, 43(1), 99–110.CrossRefGoogle Scholar
  54. Whaley, A. L. (2001). Cultural mistrust and mental health services for African Americans: A review and meta-analysis. The Counseling Psychologist, 29(4), 513–531.CrossRefGoogle Scholar
  55. Wong, E. C., Kim, B. S. K., Zane, N. W. S., Kim, I. J., & Huang, J. S. (2003). Examining culturally based variables associated with ethnicity: Influences on credibility perceptions of empirically supported interventions. Cultural Diversity and Ethnic Minority Psychology, 9(1), 88–96.PubMedCrossRefGoogle Scholar
  56. Wong, E. C., Beutler, L. E., & Zane, N. (2007). Using mediators and moderators to test assumption underlying culturally sensitive therapies: An exploratory example. Cultural Diversity and Ethnic Minority Psychology, 13, 169–177.Google Scholar
  57. Yang, L. H., Chen, F. P., Sia, K. J., Lam, J., Lam, K., Ngo, H., … Good, B. (2014). “What matters most:” a cultural mechanism moderating structural vulnerability and moral experience of mental illness stigma. Social Science & Medicine, 103, 84–93.CrossRefGoogle Scholar
  58. Zane, N., Kim, J., Bernal, G., & Gotuaco, C. (2016). Cultural adaptations in psychotherapy for ethnic minorities: Strategies for research on culturally informed evidence-based psychological practices. In N. Zane, G. Bernal, & F. Leong (Eds.), Evidence-based psychological practice with ethnic minorities: Culturally informed research and clinical strategies (pp. 169–198). Washington DC: American Psychological Association.CrossRefGoogle Scholar
  59. Zane, N., & Ku, H. (2014). Effects of ethnic match, gender match, acculturation, cultural identity, and face concern on self-disclosure in counseling for Asian Americans. Asian American Journal of Psychology, 5(1), 66–74.CrossRefGoogle Scholar
  60. Zane, N., Sue, S., Chang, J., Huang, L., Huang, J., Lowe, S., … Lee, E. (2005). Beyond ethnic match: Effects of client–therapist cognitive match in problem perception, coping orientation, and therapy goals on treatment outcomes. Journal of Community Psychology, 33(5), 569–585.CrossRefGoogle Scholar
  61. Zane, N., & Yeh, M. (2002). The use of culturally-based variables in assessment: Studies on loss of face. In K. S. Kurasaki, S. Okazaki, & S. Sue (Eds.), Asian American mental health (pp. 123–138). New York, NY: Kluwer Academic/Plenum.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Counseling and Clinical PsychologyTeachers College, Columbia UniversityNew YorkUSA
  2. 2.Department of PsychologyUniversity of California, DavisDavisUSA

Personalised recommendations