Advertisement

Cultural Diversity

  • Martin J. La Roche
  • Michael S. Christopher
Reference work entry

Abstract:

In this chapter we present the theoretical and practical underpinnings of our culturally competent practice in psychology model. This contextually based model complements traditional clinical interventions by providing psychotherapists with a conceptual frame to guide culturally sensitive psychotherapy practice. To accomplish this goal we begin the chapter by providing an overview of the literature on cultural competence and describe several prominent cultural competency definitions, models, and guidelines. Second, we review individualistic, relational, and contextual interventions, and propose an integrative multidimensional approach in which we address strengths and weaknesses of these interventions vis-à-vis cultural competence guidelines. Third, we outline a three stage model with specific interventions that clinicians can use to enhance their cultural sensitivity in working with diverse clients. Derived from an integrative multidimensional approach, these three stages are: 1) addressing chief complaints and reducing symptoms, 2) understanding narratives, and 3) fostering empowerment. Fourth, we illustrate this approach with a clinical example and conclude with a discussion of the possibilities and challenges posed by these ideas as well as areas for future research.

Keywords

Back Pain Cultural Context Cultural Competence Chief Complaint Therapeutic Relationship 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Abreu, J. M., & Gabarain, G. (2000). Social desirability and Mexican American counselor preferences: Statistical control for a potential confound. Journal of Counseling Psychology, 47, 165–176.CrossRefGoogle Scholar
  2. Alvidrez, J., Azocar, F., & Miranda, J. (1996). Demystifying the concept of ethnicity for psychotherapy research. Journal of Consulting and Clinical Psychology, 64, 903–908.PubMedCrossRefGoogle Scholar
  3. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
  4. American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060–1073.Google Scholar
  5. American Psychological Association. (2003). Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. American Psychologist, 58, 377–402.Google Scholar
  6. American Psychological Association. (2006). Evidence-based practice in psychology: APA presidential task force on evidence-based practice. American Psychologist, 61, 271–285.Google Scholar
  7. Anchin, J. C. (2008). Contextualizing discourse on a philosophy of science for psychotherapy integration. Journal of Psychotherapy Integration, 18, 1–24.CrossRefGoogle Scholar
  8. Angus, L. E., & Mcleod, J. (Eds.). (2004). Handbook of narrative and psychotherapy. London: Sage.Google Scholar
  9. Arredondo, P., & Toporek, R. L. (2004). Multicultural counseling competencies: Ethical practice. Journal of Mental Health Counseling, 26, 44–55.Google Scholar
  10. Arredondo, P., Toporek, R. L., Brown, S., Jones, J., Locke, D. C., Sanchez, J., et al. (1996). Operationalization of the multicultural counseling competencies. Alexandria, VA: Association for Multicultural Counseling and Development.Google Scholar
  11. Arredondo, P., Toporek, R., Brown, S. P., Sanchez, J., & Stadler, H. (1996). Operationalization of the multicultural counseling competencies. Journal of Multicultural Counseling and Development, 24, 42–78.CrossRefGoogle Scholar
  12. Ballou, M., Matsumoto, A., & Wagner, M. (1992). Toward a feminist ecological theory of human nature: Theory building in response to real-world dynamics. In Ballou, M., & Brown, L. (Eds.), Rethinking mental health and disorder: Feminists perspectives. New York: Guilford.Google Scholar
  13. Beck, A. T. (1967). Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press.Google Scholar
  14. Beck, A. T. (1991). Cognitive therapy: A 30-year retrospective. American Psychologist, 46, 368–375.PubMedCrossRefGoogle Scholar
  15. Berry, J. W., & Kim, U. (1988). Acculturation and mental health. In Dansen, P. R., Berry, J. W., & Sartorius, N. (Eds.), Health and cross-cultural psychology (pp. 207–236). Newbury Park, CA: Sage.Google Scholar
  16. Betancourt, H., & López, S. (1993). The study of culture, ethnicity and race in American psychology. American Psychologist, 48, 629–637.CrossRefGoogle Scholar
  17. Breuer, J., & Freud, S. (1895). Studies on hysteria. London: Hogarth Press.Google Scholar
  18. Brown, L. S. (1994). Subversive dialogues: Theory in feminist therapy. New York: Basic Books.Google Scholar
  19. Bruner, J. (1990). Acts of meaning. Cambridge, MA: Harvard University Press.Google Scholar
  20. Bonham, V. L., Warshauer-Baker, E., & Collins, F. S. (2005). Race and ethnicity in the genome era: The complexity of the constructs. American Psychologist, 60, 9–15.PubMedCrossRefGoogle Scholar
  21. Carter, R. T., & Qureshi, A. (1995). A typology of philosophical assumptions in multicultural counseling and training. In Ponterotto, J. G., Casas, J. M., Suzuki, L. A., & Alexander, C. M. (Eds.), Handbook of multicultural counseling (pp. 239–262). Thousand Oaks, CA: Sage.Google Scholar
  22. Christopher, M. S., & Skillman, G. D. (2009). Exploring the link between self-construal and distress among African American and Asian American college students. Journal of College Counseling, 12, 44–56.CrossRefGoogle Scholar
  23. Comas-Diaz, (2006). Cultural variation in the therapeutic relationship. In Goodheart, C. D., Kazdin, A. E., & Sternberg, R. J. (Eds.), Evidence-based psychotherapy: Where practice and research meet. Washington, DC: American Psychological Association.Google Scholar
  24. Constantine, M. G., & Ladany, N. (2001). New visions for defining and assessing multicultural counseling competence. In Ponterotto, J. G., Casas, J. M., Suzuki, L. A., & Alexander, C. M. (Eds.), Handbook of multicultural counseling (pp. 482–498). Thousand Oaks, CA: Sage.Google Scholar
  25. Constantine, M. G., & Sue, D. W. (Eds.). (2005). Strategies for Building Multicultural Competence in Mental Health and Educational Settings. Hoboken, NJ: Wiley & Sons.Google Scholar
  26. Cushman, P. (1995). Constructing the self, constructing America: Studies in the cultural history of psychotherapy. New York: Addison-Wesley.Google Scholar
  27. D’Andrade, R. (1990). Some propositions about the relationship between culture and human cognition. In Stigler, J., Shweder, R., & Herdt, G. (Eds.), Cultural psychology: Essays on comparative human development (pp. 88–120). New York: Cambridge University Press.Google Scholar
  28. Davis, P., & Donald, B. (1997). Multicultural counseling competencies: Assessment, evaluation, education and training, and supervision. Thousand Oaks, CA: Sage.Google Scholar
  29. Epston, D., & White, M. (1992). Consulting your consultants: The documentation of alternative knowledges. In Epston, D., & White, M. (Eds.), Experience, contradiction, narrative and imagination. Adelaide, Australia: Dulwich Centre.Google Scholar
  30. Fowers, B. J., & Davidov, B. J. (2006). The virtue of multiculturalism: Personal transformation, character, and openness to the other. American Psychologist, 61, 581–594.PubMedCrossRefGoogle Scholar
  31. Fowers, B. J., & Richardson, F. (1996). Why is multiculturalism good? American Psychologist, 51, 609–621.CrossRefGoogle Scholar
  32. Freud, S. (1933). New introductory lectures on psychoanalysis. Standard Edition. London: Hogarth.Google Scholar
  33. Garro, L. C. (2003). Narrating troubling experiences. Transcultural Psychiatry, 40, 5–44.PubMedCrossRefGoogle Scholar
  34. Garro, L. C. (2005). “Effort after meaning” in everyday life. In Casey, C., & Edgerton, R. B. (Eds.), A companion to psychological anthropology: Modernity and psychocultural change (pp. 48–71). Oxford: Blackwell.Google Scholar
  35. Geertz, C. (1973). Interpretation of cultures. New York: Basic Books.Google Scholar
  36. Gelso, C., & Mohr, J. (2001). The working alliance and the transference-countertransference relationship: Their manifestation with racial/ethnic and sexual orientation minority clients and therapists. Applied and Preventive Psychology, 10, 51–66.CrossRefGoogle Scholar
  37. Gergen, K. (1991). The saturated self: Dilemmas of identity in contemporary life. New York: Basic Books.Google Scholar
  38. Gold, J., & Watchel, P. (1993). Cyclical psychodynamics. In Stricker, G., & Gold, J. (Eds.), Comprehensive handbook of psychotherapy integration. New York: Plenum.Google Scholar
  39. Guarnaccia, P. J., & Rodriguez, O. (1996). Concepts of culture and their role in the development of culturally competent mental health services. Hispanic Journal of Behavioral Sciences, 18, 419–443.CrossRefGoogle Scholar
  40. Hall, C. C. I. (1997). Cultural malpractice: The growing obsolescence of psychology with the changing U.S. population. American Psychologist, 52, 642–651.PubMedCrossRefGoogle Scholar
  41. Haynes, R. B., Devereaux, P. J., & Guyatt, G. H. (2002). Physicians’ and patients’ choices in evidence based practice: Evidence does not make decisions, people do. British Medical Journal, 324, 1350–1414.PubMedCrossRefGoogle Scholar
  42. Herman, J. L. (1992). Trauma and recovery: The aftermath of violence from domestic abuse to political terror. New York: Basic Books.Google Scholar
  43. Helms, J., & Cook, D. (1999). Using race and culture in counseling and psychotherapy. Boston: Allyn & Bacon.Google Scholar
  44. Helms, J. E., Jernigan, M., & Macher, J. (2005). The meaning of race in psychology and how to change it: A methodological perspective. American Psychologist, 60, 27–36.PubMedCrossRefGoogle Scholar
  45. Horowitz, M. J. (1986). The stress response syndromes. Northvale, NJ: Jason Aronson.Google Scholar
  46. Jordan, J. V., & Surrey, J. L. (1983). Women and empathy: Implications for psychological development and psychotherapy. Wellesley, MA: Stone Center for Developmental Services and Studies.Google Scholar
  47. Jordan, J. V., Walker, M., & Hartling, L. M. (2004). The complexity of connection: Writings from the Stone Center’s Jean Baker Miller Training Institute. New York: Guilford.Google Scholar
  48. Kazarian, S., & Evans, D. (1998). Cultural clinical psychology: Theory, research and practice. New York: Oxford University Press.Google Scholar
  49. Kazdin, A. E. (2008). Evidence-based treatment and practice: New opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care. American Psychologist, 63, 146–159.PubMedCrossRefGoogle Scholar
  50. Kohut, (1984). How does analysis cure? Chicago: University of Chicago Press.Google Scholar
  51. Klein, M. (1955). New directions in psycho-analysis; the significance of infant conflict in the pattern of adult behaviour. New York: Basic Books.Google Scholar
  52. Kleinman, A. (1988). The illness narratives: Suffering, healing, and the human condition. New York: Basic Books.Google Scholar
  53. Kleinman, A. (2001). A psychiatric perspective on global change. Harvard Review of Psychiatry, 9, 46–47.PubMedCrossRefGoogle Scholar
  54. Klerman, G. L., Weissman, M. M., Rounsaville, B. J., & Chevron, E. S. (1984). Interpersonal psychotherapy for depression. New York: Basic Books.Google Scholar
  55. Lakes, K., López, S. R., & Garro, L. C. (2006). Cultural competence and psychotherapy: Applying anthropologically informed conceptions of culture. Psychotherapy: Theory, Research, Practice, & Training, 43, 380–396.CrossRefGoogle Scholar
  56. Landrine, H., & Klonoff, E. A. (1996). African American acculturation. Thousand Oaks, CA: Sage.Google Scholar
  57. La Roche, M. (1999). Culture, transference, and countertransference among Latinos. Psychotherapy, 36, 389–397.CrossRefGoogle Scholar
  58. La Roche, M. (2002). Psychotherapeutic Considerations in treating Latinos. Harvard Review of Psychiatry, 10, 115–122.PubMedCrossRefGoogle Scholar
  59. La Roche, M. (2005). The cultural context and the psychotherapeutic process: Towards a culturally sensitive psychotherapy. Journal of Psychotherapy Integration, 15, 169–185.CrossRefGoogle Scholar
  60. La Roche, M., & Christopher, M. S. (2008). Culture and empirically supported treatments: On the road to a collision? Culture and Psychology, 14, 333–356.CrossRefGoogle Scholar
  61. La Roche, M., & Maxie, A. (2003). Ten considerations in addressing cultural differences in psychotherapy. Professional Psychology: Research and Practice, 34, 180–186.CrossRefGoogle Scholar
  62. Lehrman, S. (2006). The implicit prejudice. Scientific American, 294, 32–34.PubMedCrossRefGoogle Scholar
  63. López, S. R. (1997). Cultural competence in psychotherapy: A guide for clinicians and their supervisors. In Watkins, C. E. (Ed.), Handbook of psychotherapy supervision (pp. 570–588). New York: Wiley.Google Scholar
  64. López, S. R., & Guarnaccia, P. (2000). Cultural psychopathology: Uncovering the social world of mental illness. Annual Review of Psychology, 51, 571–598.PubMedCrossRefGoogle Scholar
  65. López, S. R., Kopelowicz, A., & Canive, J. M. (2002). Strategies in developing culturally congruent family interventions for schizophrenia: The case of Hispanics. In Lefley, H. P., & Johnson, D. L. (Eds.), Family interventions in mental illness: International perspectives (pp. 61–90). Westport, CT: Praeger.Google Scholar
  66. Marsella, A. J. (1998). Toward a “global-community psychology”: Meeting the needs of a changing world. American Psychologist, 53, 1282–1291.CrossRefGoogle Scholar
  67. Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50, 370–396.CrossRefGoogle Scholar
  68. Maslow, A. H. (1969). Toward a psychology of being. Princeton, NJ: Van Nostrand.Google Scholar
  69. Mattingly, C. (2008). Reading minds and telling tales in a cultural borderland. Ethos, 36, 136–154.PubMedCrossRefGoogle Scholar
  70. McIntosh, P. (1988). White privilege: Unpacking the invisible knapsack (Working Paper 189). Wellesley, MA: Wellesley College Center for Research on Women.Google Scholar
  71. Miller, J. B., & Stiver, I. P. (1997). The healing connection: How women form relationships in therapy and in life. Boston: Beacon.Google Scholar
  72. Mitchell, S. (1988). Relational concepts in psychoanalysis: An integration. Cambridge, MA: Harvard University Press.Google Scholar
  73. Moghaddam, F. M., & Studer, C. (1999). Cross-cultural psychology: The frustrated gadfly’s promises, potentialities, and failures. In Fox, D., & Prilleltensky, I. (Eds.), Critical psychology: An introduction. New York: Sage.Google Scholar
  74. Muñoz, R. F., & Mendelson, T. (2005). Toward evidence-based interventions for diverse populations: The San Francisco General Hospital prevention and treatment manuals. Journal of Consulting and Clinical Psychology, 73, 790–799.PubMedCrossRefGoogle Scholar
  75. National Council of Schools and Programs in Professional Psychology (NCSPP). (2002). Diversity competency statement. Retrieved July 9, 2008, from http://www.ncspp.info/div.htm.
  76. National Council of Schools and Programs in Professional Psychology (NCSPP). (2007). Competency developmental achievement levels (DALS). Retrieved July 13, 2008, from http://www.ncspp.info/DALof%20NCSPP%209-21-07.pdf.
  77. Norasakkunkit, V., & Kalick, S. M. (2002). Culture, ethnicity, and emotional distress measures: The role of self-construals and self-enhancement. Journal of Cross-Cultural Psychology, 33, 56–70.CrossRefGoogle Scholar
  78. Norcross, J. C., & Goldfried, M. R. (Eds.). (2005). Handbook of psychotherapy integration. New York: Oxford University Press.Google Scholar
  79. Peterson, F., Coleman, F., Dobbins, J., & Boyce, J. (2002). Understanding the importance of cultural competency in consultation, psychotherapy and supervision. In VandeCreek, L., & Jackson, T. (Eds.), Innovations in clinical practice: A source book (pp. 343–354). Sarasota, FL: Professional Press.Google Scholar
  80. Phinney, J. S. (1996). When we talk about American ethnic groups, what do we mean? American Psychologist, 51, 918–927.CrossRefGoogle Scholar
  81. Pope-Davis, D. P., & Dings, J. G. (1995). The assessment of multicultural counseling competencies. In Ponterotto, J. G., Casas, J. M., Suzuki, L. A., & Alexander, C. M. (Eds.), Handbook of Multicultural Counseling (pp. 287–311). Thousand Oaks, CA: Sage.Google Scholar
  82. Prilleltensky, I. (1999). Values, assumption and practice: Assessing the moral implications of psychological discourse and action. American Psychologist, 53, 202–213.Google Scholar
  83. Ridley, C. (2001). Building self-esteem in racially diverse populations. Christian Counseling Today, 9, 46–49.Google Scholar
  84. Rogers, C. (1961). On becoming a person. Boston: Houghton Mifflin.Google Scholar
  85. Rowe, D. C. (2002). IQ, birth weight, and number of sexual partners in White, African American, and mixed race adolescents. Populations, 23, 513–524.CrossRefGoogle Scholar
  86. Ryder, A. G., Yang, J., Zhu, X., Yao, S., Yi, J., Heine, S. J., et al. (2008). The cultural shaping of depression: Somatic symptoms in China, psychological symptoms in North America? Journal of Abnormal Psychology, 117, 300–313.PubMedCrossRefGoogle Scholar
  87. Saldaña, D. H. (2001), Cultural competency: A practical guide for mental health service providers. San Antonio, TX: Foundation for Mental Health.Google Scholar
  88. Samuda, R. J., Feuerstein, R., Kaufman, A. S., Lewis, J. E., & Sternberg, R. J. (1998). Advances in cross-cultural assessment. Thousand Oaks, CA: Sage.Google Scholar
  89. Shweder R. J. (1995). Cultural psychology: What is it? In Rule-Goldberger, N., Bennet, J., & Veroff, M. (Eds.), The culture and psychology reader (pp. 41–86). New York: New York University Press.Google Scholar
  90. Sternberg, (2006). Evidence-based practice: Gold standard, gold plated, or fool’s gold? In Goodheart, C. D., Kazdin, A. E., & Sternberg, R. J. (Eds.), Evidence-based psychotherapy: Where practice and research meet. Washington, DC: American Psychological Association.Google Scholar
  91. Stricker, G., & Gold, J. R. (Eds.). (1993). Comprehensive handbook of psychotherapy integration. New York: Plenum.Google Scholar
  92. Sue, D. W. (2001). Multidimensional facets of cultural competence. Counseling Psychologist, 29, 790–821.CrossRefGoogle Scholar
  93. Sue, D. W., Arredondo, P., & Mc Davis, R. J. (1992). Multicultural counseling competencies and standards: A call to the profession. Journal of Counseling and Development, 70, 477–483.CrossRefGoogle Scholar
  94. Sue, D. W., Bernier, J., Durran, M., Feinberg, L., Pedersen, P., Smith, E., et al. (1982). Position paper: Cross-cultural counseling competencies. Counseling Psychologist, 10, 45–52.CrossRefGoogle Scholar
  95. Sue, D. W., Carter, R. T., Casas, J. M., Fouad, N. A., Ivey, A. E., Jensen, M., LaFromboise, T., Manese, J. E., Ponterotto, J. G., & Vazquez–Nutall, E. (1998). Multicultural counseling competencies: Individual and organizational development. Thousand Oaks, CA: Sage.Google Scholar
  96. Sue, D. W. & Sue, D. (2007). Foundations of counseling and psychotherapy: Evidence-based practices for a diverse society. New York: Wiley.Google Scholar
  97. Sue, D. W., & Torino, G. (2005). Racial cultural competence: Awareness, knowledge and skills. In Carter, R. T. (Ed.), Handbook of multicultural psychology and counseling (pp. 3–18). New York: Wiley.Google Scholar
  98. Sue, S. (1998). In search of cultural competence in psychotherapy and counseling. American Psychologist, 53, 440–448.PubMedCrossRefGoogle Scholar
  99. Sue, S. (1999). Science, ethnicity and bias: Where have we gone wrong? American Psychologist, 54, 1070–1077.PubMedCrossRefGoogle Scholar
  100. Sue, S. (2003). In defense of cultural competency in psychotherapy and treatment. American Psychologist, 58, 964–970.PubMedCrossRefGoogle Scholar
  101. Sullivan, H. S. (1953). The interpersonal theory of psychiatry: A systematic presentation of the later thinking of one of the great leaders in modern psychiatry. New York: W.W. Norton.Google Scholar
  102. Task Force on the Promotion and Dissemination of Psychological Procedures. (1995). Training in dissemination of empirically-validated psychological treatments. The Clinical Psychologist, 48, 3–23.Google Scholar
  103. Tseng, W. S., & Streltzer, J. (2001). Culture and psychotherapy. New York: American Psychiatric.Google Scholar
  104. U.S. Department of Health and Human Services. (1999). Mental health: A report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.Google Scholar
  105. U.S. Department of Health and Human Services. (2001). Mental health: Culture, race and ethnicity – A supplement to mental health: A report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services, Public Health Services, Offices of the Surgeon General.Google Scholar
  106. Wampold, B. E. (2007). Psychotherapy: The humanistic (and effective) treatment. American Psychologist, 62, 855–873.PubMedCrossRefGoogle Scholar
  107. Whaley, A. L., & Davis, K. E. (2007). Cultural competence and evidence-based practice in mental health services: A complementary perspective. American Psychologist, 62, 563–574.PubMedCrossRefGoogle Scholar
  108. Winnicot, D. W. (1969). Playing and reality. New York: Routledge.Google Scholar

Copyright information

© Springer Science+Business Media LLC 2010

Authors and Affiliations

  • Martin J. La Roche
    • 1
  • Michael S. Christopher
    • 2
  1. 1.Harvard Medical SchoolCambridgeUSA
  2. 2.Pacific UniversityPortlandUSA

Personalised recommendations