Training Therapists to Be Culturally Sensitive with Asian American Women Clients

SUMMARY

We describe here a developmental sequence of three key training experiences that contribute to developing cultural sensitivity for clinicians who are not of Asian heritage and are working with Asian American women. The sequence reflects and illustrates our guiding assumptions for developing multicultural sensitivity, including an emphasis on cultural self-awareness and a reflexive approach to knowledge acquisition and clinical practice. Effects of these training experiences are illustrated through three case examples of therapy with Asian American women written by an African American male and two European American female therapists at different stages in their training.     

Collaborative Empiricism in Culturally Sensitive Cognitive Behavior Therapy

Collaborative empiricism, one of the main tenets of cognitive behavior therapy, could encounter conceptual and practical problems when applied to culturally sensitive settings. This paper sets out to discuss issues in applying collaborative empiricism to Chinese patients, taking into account a number of cultural determinants such as collectivism, hierarchical perception, passivity, reticence, and superstition. These will be discussed in light of studies on the impact of Chinese culture on patient behavior. Evidence on the successful application of cognitive behavior therapy to Chinese patients will also be presented. There is a pressing need for culturally sensitive clinical procedures and skills adaptation. A case study is presented to illustrate how culturally mediated resistance in collaborative empiricism can be overcome by good clinical practice.     

Marriage and Family Therapy with Low-Income Clients: Professional,Ethical, and Clinical Issues

Economic stress greatly increases the likelihood of mental health issues occurring within a family. Although this is widely known within the mental health profession, there is a lack of literature that assists therapists in working effectively with low-income clients. As a result, marriage and family therapists may be ill equipped to meet the needs of those in poverty, and may even be conducting therapy that is ethically unsound. The authors of this article discuss several ethical and professional issues regarding therapy with families in poverty. A number of suggestions are presented for improving the effectiveness of therapy with low-income clients. Michele E. Grimes and Alyssa D. McElwain are masters students in Marriage and Family Therapy at Purdue University Calumet, Hammond, IN. Michele E. Grimes and Alyssa D. McElwain contributed equally to this article.     

Developing a Culturally Sensitive Treatment Modality for Bilingual Spanish-Speaking Clients: Incorporating Language and Culture in Counseling

The article examines the role of language and culture in the mental health treatment of Hispanics. Although mental health practitioners and researchers have turned their attention to developing culturally sensitive therapeutic practices, an integrative framework is lacking. The proposed conceptual framework illustrates how the dimensions of acculturation, language dominance and preference, and cultural norms, values, and beliefs affect the assessment ofpsychological and physical health. Furthermore, a number of intervention strategies are described in a cultural context. This framework provides a meaningful method of developing an effective treatment program for the bilingual Spanish-speaking client.     

The Internal Dialogue of Culturally Different Clients: An Application of the Triad Training Model

This article describes a training design to help counselor trainees perceive the positive and negative messages in a client's internal dialogue. Twenty graduate counselors-in-training produced two 10-minute interviews with simultaneous feedback from an anticounselor and a procounselor in simulated interviews.     

Conceptualizing Culturally Infused Engagement and Its Measurement for Ethnic Minority and Immigrant Children and Families

Despite the central role culture plays in racial and ethnic disparities in mental health among ethnic minority and immigrant children and families, existing measures of engagement in mental health services have failed to integrate culturally specific factors that shape these families’ engagement with mental health services. To illustrate this gap, the authors systematically review 119 existing instruments that measure the multi-dimensional and developmental process of engagement for ethnic minority and immigrant children and families. The review is anchored in a new integrated conceptualization of engagement, the culturally infused engagement model. The review assesses culturally relevant cognitive, attitudinal, and behavioral mechanisms of engagement from the stages of problem recognition and help seeking to treatment participation that can help illuminate the gaps. Existing measures examined four central domains pertinent to the process of engagement for ethnic minority and immigrant children and families: (a) expressions of mental distress and illness, (b) causal explanations of mental distress and illness, (c) beliefs about mental distress and illness, and (d) beliefs and experiences of seeking help. The findings highlight the variety of tools that are used to measure behavioral and attitudinal dimensions of engagement, showing the limitations of their application for ethnic minority and immigrant children and families. The review proposes directions for promising research methodologies to help intervention scientists and clinicians improve engagement and service delivery and reduce disparities among ethnic minority and immigrant children and families at large, and recommends practical applications for training, program planning, and policymaking.     

Culturally Sensitive Family Assessment: An Evaluation of the Family Assessment Device Used with Hawaiian-American and Japanese-American Families

This article reports the results of a study of the McMaster Family Assessment Device (FAD) used with samples drawn from two non-Anglo ethnic groups: Hawaiian-Americans and Japanese-Americans living in Hawaii. The results showed that the FAD appeared to make appropriate assessments of Hawaiian-American study participants' families and inappropriate assessments of Japanese-American study participants' families. Results also suggested that cultural norms regarding family functioning may vary according to socioeconomic status. FAD modifications are suggested.     

Chinese Values in Supervisory Discourse: Implications for Culturally Sensitive Practices

Despite the long history of work addressing cultural competency, relatively little attention has been given to how supervisory discourse affects the supervision unit in any context—particularly within the Chinese context. This article reflects a consideration of Chinese cultural values within the supervisor-supervisee discourse and their potentially positive and negative effects on the supervisory system. We describe an approach to supervision that details how to address intersecting forms of cultural values such as social hierarchy, piety, face-concerns, other-centeredness, and harmony that may be operating within the Chinese social and professional context. We include three supervisory practices to address Chinese values, with case examples that illustrate them.     

Brief Christian and Non-Christian Rational-Emotive Therapy With Depressed Christian Clients: An Exploratory Study

The current outcome study operationalized a brief “Christian” form of rational-emotive therapy (CRET) and compared the therapeutic efficacy of this treatment with a standard version of brief rational-emotive therapy (RET) with depressed Christian clients. Results indicated that both treatments were effective in reducing depression and automatic negative thoughts, while only the CRET reduced clients' irrational beliefs. No between-group differences were obtained for clients' perceptions of the counselor. Findings are discussed in terms of applied integration issues and the long-standing antagonism of rational-emotive philosophy toward religious beliefs.     

Challenges to the Career Development of Urban Racial and Ethnic Minority Youth: Implications for Vocational Intervention

Urban racial and ethnic minority youth experience a variety of internal and external challenges to their career development. This article discusses several potential barriers to successful career attainment experienced by racial and ethnic minority youth and identifies a series of recommendations that vocational counselors may wish to consider in addressing the career development needs of this population.     

Making Counseling Culturally Appropriate: Intervention With a Montagnard Refugee

This article describes an intervention with a distressed Montagnard refugee in a context sensitive to Southeast Asian culture. Relevant interventions are discussed in relation to the current available literature on counseling with Southeast Asian refugees in America.     

Acceptance and Mindfulness Techniques as Applied to Refugee and Ethnic Minority Populations With PTSD: Examples From "Culturally Adapted CBT"

In this article we illustrate how we utilize acceptance and mindfulness techniques in our treatment (Culturally Adapted CBT, or CA-CBT) for traumatized refugees and ethnic minority populations. We present a Nodal Network Model (NNM) of Affect to explain the treatment's emphasis on body-centered mindfulness techniques and its focus on psychological flexibility. We explain the definition of mindfulness that guides our treatment, and we outline a typology of mindfulness states and show how many of the techniques in our treatment can be analyzed by these categories. We argue that acceptance and mindfulness are therapeutic for refugees and minority populations for several reasons. These include their increasing psychological flexibility, decreasing somatic distress, decreasing rumination, serving as emotion regulation techniques, decreasing the attentional bias to threat, and forming part of a new adaptive processing mode (which in CA-CBT centers on psychological flexibility). We describe the specific ways we teach acceptance and mindfulness with Latino and Southeast Asian refugee populations and present case examples of the treatment of a traumatized Latino and Cambodian patient.     

Promoting the Culturally Sensitive Diagnosis of Mexican Americans: Some Personal Insights

This article presents a series of personal guidelines for promoting the culturally sensitive psychiatric diagnosis of Mexican American/Chicano clients. These guidelines are primarily based on the authors' collective experiences in diagnosing and treating this population.     

Parameters for Creating Culturally Sensitive CBT: Implementing CBT in Global Settings

The current article is a commentary on the article, “A Common Elements Approach for Adult Mental Health Problems in Low- and Middle-Income Countries,” which describes a form of transdiagnostic CBT and its implementation among a highly traumatized Burmese and Iraqi group. Murray et al.’s (this issue) article is one of several new studies indicating the efficacy of CBT in global contexts. In this commentary, we suggest a set of parameters to create culturally sensitive CBT in global settings in a way to maximize efficacy and effectiveness. When applicable, we will discuss ways in which these parameters are illustrated by Murray et al. in this pilot study. These parameters can be used more generally to design culturally sensitive CBT studies in global contexts and to evaluate such studies. Some examples of these parameters are culturally appropriate framing of CBT techniques, assessing and addressing key local complaints (e.g., somatic symptoms) and local catastrophic cognitions, and incorporating key local sources of recovery and resilience.     

Empowering Ethnically and Racially Diverse Clients Through Prejudice Reduction: Suggestions and Strategies for Counselors

This article focuses on the persistent problems of prejudice in multicultural societies. Various theories of prejudice and other psychological, social, and political factors that contribute to prejudice are discussed. The salient feature of this article is the demonstration of several counseling theories and techniques as applied to case vignettes dealing with prejudice and racism.     

Collaboration and a Self-Help Orientation in Therapy with Suicidal Clients

Working with suicidal clients historically has placed a heavy burden of responsibility on the therapist for a successful outcome. This orientation generally has left clinicians feeling stressed and in need of controlling their clients' behavior; clients, in turn, often have developed unrealistic expectations of therapy or resistance of the therapist's interventions. In this context, the chance for a potentially valuable collaboration between client and therapist is often lost. This paper builds on previous work that has introduced the notion of a collaborative working relationship with suicidal clients. It is argued that the therapeutic process ideally should not only utilize the therapist's knowledge and skills in treating suicidal clients, but also cultivate self-efficacy by encouraging the client to adopt a self-help orientation to therapy. Several general principles of a collaborative/self-help orientation to working with suicidal clients are discussed and a variety of specific therapeutic strategies consistent with this orientation are described.     

Value Conflict Resolution: A Training Model for Counselors of Minority Clients

It is assumed that the employment counselor controls what happens in the counseling session by virtue of position and superior knowledge of what the counseling process can and cannot provide. When employment counselors counsel individuals who have cultural and racial backgrounds different from their own, the probability of value conflict in problem solving and decision making is increased. Counselor control over the counseling process suggests that these conflicts will often be resolved according to the value preferences of the counselor. Failure to consider the value input of the client leads to the development of plans for action that don't work. The Carkhuff helping model is presented to show where counselor-client value conflicts are likely to occur, and a value conflict resolution training model is provided to help counselors assess value conflicts and resolve them in ways that promote client-counselor success.     

Considerations for Culturally Competent Cognitive-Behavioral Therapy for Depression with Hispanic Patients

The purpose of this paper is to outline considerations for adapting cognitive-behavioral therapy (CBT) to Hispanic patients who have recently immigrated, particularly those presenting with depressive symptoms. Culturally competent CBT is framed within a model originally proposed by Rogler and his colleagues (1987). The considerations outlined by the model include ensuring that treatments provide access, are selected based on compatibility with Hispanic culture, and are adapted to fit the culture. Recommendations for culturally adapting CBT include consideration of each patient's unique ethnocultural background and their treatment expectations, as well as culturally relevant interpersonal styles, values, and metaphors/language. In addition, specific strategies for conceptualizing and conducting CBT techniques are discussed.