Challenges Faced by Genetics Service Providers’ Practicing in a Culturally and Linguistically Diverse Population: An Australian Experience

This paper explores the perceived challenges facing clinical genetics practitioners in multicultural Australia. Focus groups conducted with 53 practitioners explored: 1) participants’ experiences and definitions of cultural diversity; 2) their use of educational resources with clients; 3) their experiences with culturally diverse groups/individuals in practice; 4) their experiences working with interpreters; and 5) the impact culturally specific educational training and/or experiential learning had on their confidence or practice when dealing with culturally diverse clients. Participants viewed culture as extending beyond traditional definitions such as ethnicity, language and religion. Most respondents had experienced positive results working with health care interpreters, although at times, this was a challenge for the family as they preferred privacy and the use of family members as interpreters. Another commonly reported challenge was the limited availability of reliable, culturally appropriate translated resources. Some participants expressed concern that learning theories about specific cultures may lead to stereotypes and that opportunities for formal cultural competence training were limited. Recommendations for practice include the targeting of educational resources to meet the needs of a diverse community and placing cultural competence on the agenda for ongoing training and maintenance of professional standards for clinical genetics practitioners to avoid the current ad hoc approach.     

Social Justice and Multicultural Issues: Implications for the Practice and Training of Counselors and Counseling Psychologists

The authors discuss the historical and contemporary connection to social justice issues in the fields of counseling and counseling psychology via the multicultural counseling movement. In addition, the authors present ways in which social justice issues can be addressed in counselors' and counseling psychologists' work with clients from diverse cultural backgrounds and in graduate training programs.     

Working in Indigenous Contexts: Self‐Reported Experiences of Non‐Indigenous Australian Psychologists

Despite assertions in the literature that psychologists adopt culturally inappropriate strategies for working with Indigenous clients, there is little empirical evidence about this. The aim of this study was to document the self‐reported experiences of non‐Indigenous psychologists working with Indigenous clients, the factors that they felt constrain these interactions, and the clinical, assessment and communication strategies they perceived as effective in Indigenous contexts. Structured interviews were held with 23 psychologists, 18 females and five males, with age groups ranging from 20–30 to 50+. Thematic analysis of the data revealed that participants experienced contradictions between the typical Western white psychologists' ways of interacting with clients, which they had been taught and the typical ways in which relationships are structured in Indigenous communities. The results suggest that the Western model of psychological training does not work very well in Indigenous contexts, and that psychologists working in Indigenous contexts have to work out their own methods on a trial‐and‐error basis. This points to the need for more systematic cultural competence training. However, there is a lack of research into the effectiveness of psychological intervention from the viewpoints of Indigenous clients themselves.     

“We are better and happier if we are inclusive.” Therapist perspectives on the importance of LGB cultural competence in a mental health setting

Lesbian, gay and bisexual people are more likely than their heterosexual counterparts to report dissatisfaction after accessing a counselling or psychological service. Greater dissatisfaction may result from therapists who focus on psychopathology without considering cultural context. Research has demonstrated therapists' cultural competence (attitudes, knowledge and skills) may influence effective service provision to LGB people. Counsellors and psychologists (N = 10) were interviewed to determine the sources of information influencing the cultural competence and LGB cultural competence practices used by therapists in their clinical practice. Three themes were developed from semistructured interviews: (1) the importance of multiple sources of cultural competence; (2) applying cultural competence improves the therapeutic process; and (3) ensuring visual cues of affirmation are affirming, not pathologising. Theme 1 highlighted that initial professional training, cultural competence training and lived experience could be triangulated to assist therapists in improving their cultural competence. Theme 2 highlighted that cultural competence improves the therapeutic process by ensuring therapists can demonstrate affirming attitudes, knowledge about LGB people and culturally affirming skills to work effectively with LGB clients. The final theme explored the need for therapists to create an inclusive space for LGB clients. Recommendations for improving clinical practices and tools to enhance cultural competence are discussed.     

Counsellors' self-perceived multicultural competencies model

This study aimed to develop a UK instrument measure of counsellors’ multicultural competencies. Also, it intended to analyse to what extent multicultural competencies have an influence in counselling practice in terms of processes and interventions.

The study was an expansion of the American multicultural competencies model, which related cultural competence to a combination of three factors: cultural beliefs, cultural knowledge and cultural skills. Results partially supported the hypothesis, which predicted that counsellors would present high correlation rates between cultural skills, cultural knowledge and cultural beliefs when self-evaluating their levels of multicultural competence.

The study's findings present alternative three-dimensional multicultural models that indicated how counsellors perceived multicultural competence based on both societal (e.g. race, class, patriotism) and functional (e.g. family, social norms and groups). It also discusses the correlations between cultural skills, cultural knowledge and cultural beliefs and how they played a part in helping counsellors to further understand their multicultural competencies and limitations. Finally, it is proposed that future research should investigate the possibility of developing multidimensional or multi-axial models as an alternative way of further developing the counsellors’ multicultural competencies models which emerged from this study.     

Clinical psychologists' attitudes to lesbians

This study begins the process of examining clinical psychologists' competence in dealing with lesbian clients by assessing their attitudes to lesbians and lesbianism. Attitudinal questionnaires were sent to 200 chartered clinical psychologists and 69 (34.5%) were returned. Respondents displayed generally positive attitudes, with only two out of 12 attitudinal items failing to attract attitudinally positive responses from more than three-quarters of the sample. Yet, because of the possible unrepresentativeness of the sample and the potentially tenuous attitude–behaviour link, it is recommended that consideration of lesbian issues should be explicitly addressed in clinical psychology training.     

South Korean counselors’ perceived multicultural counseling competence: Relationship with openness to experience,perceived general counseling competence,and multicultural counseling education/practice

This study investigated variables related to the perceived multicultural counseling competence (MCC) of South Korean counselors. The relationship between perceived MCC and demographic information was explored, and effects of openness to experience, general counseling competence, and multicultural counseling education/practice on perceived MCC were examined.  Results revealed no relationship with demographic information and perceived MCC and significant effects of general counseling competence and multucultural counseling education/practice on perceived MCC. Implications for multicultural counseling training and future research are discussed.     

Australian psychologists' attitudes towards suicide and self‐harm

An exploratory study of 81 Australian psychologists' attitudes towards suicide and self‐harm was undertaken. Two attitudinal measures, one knowledge measure and demographic information, were used to assess the relationships between attitudes, knowledge, gender, age, years of professional experience, and previous experience with suicidal and self‐harming clients. Among this sample, attitudes towards suicide and self‐harm were generally positive and participants displayed high levels of knowledge of self‐harm. Age and years of experience were related to participants' attitudes, with younger psychologists reporting greater confidence in working with these clients and believing in the right of an individual to decide when to die. Future research is needed to determine the impact of psychologists' attitudes on their behaviour towards suicidal and self‐harming clients.     

Culturally educated questioning: Toward a skills-based approach in multicultural counselor training

Increased resources are being committed to the multicultural training of counselors. Despite these gains, training continues to focus almost exclusively on the acquisition of cultural awareness and culture-specific knowledge. Valuable though they are, awareness and knowledge, the authors argue, do not necessarily result in effective multicultural counseling skill. Therefore, it is recommended that current training models be modified to include techniques through which cultural knowledge can be synthesized into effective counseling interventions. Specifically, it is suggested that programs stress the need to conduct cultural assessments of clients using what the authors term “culturally educated questioning”: empirically rooted inquiry designed to elicit from clients clinically relevant cultural data. The benefits of culturally educated questioning, including its safeguards against cultural stereotyping, are discussed.     

Foreign‐Born Therapists: How Acculturation and Supervisors' Multicultural Competence Are Associated With Clinical Self‐Efficacy

The authors examined the associations between acculturation, supervisors' multicultural competence, and clinicians' self‐efficacy in a sample of 153 immigrant therapists currently practicing in the United States. Participants completed a demographic questionnaire and 3 additional questionnaires that examined their levels of acculturation, perceived supervisors' multicultural competence, and clinical self‐efficacy. Results suggested that perceived prejudice, not level of acculturation, was significantly associated with foreign‐born therapists' clinical self‐efficacy. Perceived supervisors' multicultural competence was significantly associated with therapists' clinical self‐efficacy. Recommendations for supervisors working with foreign‐born therapists are provided. Los autores examinaron las asociaciones entre aculturación, competencia multicultural de los supervisores y autoeficacia de los profesionales clínicos en una muestra de 153 terapeutas inmigrantes actualmente en activo en los Estados Unidos. Los participantes completaron un cuestionario demográfico y tres cuestionarios adicionales que examinaron sus niveles de aculturación, la competencia multicultural percibida de sus supervisores y la autoeficacia clínica. Los resultados sugieren que los prejuicios percibidos, no el nivel de aculturación, están asociados de forma significativa con la autoeficacia clínica de los terapeutas nacidos en el extranjero. La competencia multicultural percibida de sus supervisores está asociada significativamente con la autoeficacia clínica de los terapeutas. Se proporcionan recomendaciones para supervisores que trabajan con terapeutas nacidos en el extranjero.     

An Investigation of Relationships among Genetic Counselors’ Supervision Skills and Multicultural Counseling Competence

As racial and ethnic diversity increase in the U.S., genetic counselor multicultural competence is growing in importance. In mental health counseling, supervisor multicultural competence has been shown to promote supervisees’ multicultural competence. Moreover, developmentally-advanced supervisors tend to be more effective. This study was designed to investigate relationships among genetic counselor supervisors’ perceived multicultural counseling competence and development as supervisors, and their ability to evaluate a supervisee’s multicultural skills. One hundred twenty-two supervisors completed an online survey of demographics, the Multicultural Counseling Knowledge and Awareness Scale, the Supervisor Development Scale, and a hypothetical vignette in which they evaluated a supervisee’s multicultural skills and provided written feedback. Stepwise multiple regression yielded five significant predictors accounting for 31% of the variance in accuracy of supervisor evaluations of the student: multicultural awareness, multicultural knowledge, age, supervision experience, and supervisor development. Six feedback themes were identified from written responses. Practice and research suggestions are provided.     

Preparing Culturally Effective Counselors

The preparation of culturally effective counselors is a familiar topic in the counseling literature. Counselor educators and practitioners have regularly discussed cultural barriers in the counseling process and have proposed models for working more effectively with multicultural populations. Still, there is no counselor education program in the United States that trains students in the special problems and advantages of counseling culturally different clients. Now more than ever, there are many compelling reasons to prepare culturally effective counselors. They include (a) the multicultural overtones of the American population; (b) the growing number of new immigrants and refugees; (c) the expressed and perceived needs of counselors working with multicultural groups; and (d) the naming of counselors as “necessary” recipients of federal training funds to develop better bilingual programs. The authors propose a counselor training program with a specialization in bilingual-multicultural education. This requires specific attitudes, skills, and competencies based on the interdisciplinary philosophies of counseling, bilingual education, and multicultural education.     

Multicultural Competence and Counselor Training: A National Survey

The extent to which practicing professional counselors perceive themselves as multiculturally competent and the basis for their training experiences in multicultural counseling have not been determined. This article reports the results of a survey on practicing professional counselors' perceptions of their multicultural competence and the nature of their pre- and in-service professional preparation in this area. There was no significant difference in self-perceived multicultural competence between graduates of Council for Accreditation of Counseling and Related Educational Programs (CACREP) accredited and nonaccredited programs. However, ethnicity was related to higher levels of perceived multicultural competence.     

Visions and Realities: Supervisee Perspectives of Multicultural Supervision

This article provides an overview of the experiences of 4 psychologists‐in‐training as supervisees in multicultural supervision relationships. Grounded in the supervision and multicultural literature, this article helps both supervisors and supervisees to (a) understand supervisees' needs and perspectives for culturally integrated supervision and (b) discuss multicultural issues during supervision. Recommendations are provided to facilitate the development of effective multicultural supervision. Este artículo muestra un resumen de las experiencias de 4 psicológos‐en‐entrenamiento bajo supervisión en relaciones de supervisión multiculturales. En base a la literatura multicultural y de supervisión, este artículo ayuda a supervisores y supervisados a (a) entender las necesidades de los supervisados y sus perspectivas hacia temas que integran la cultura en la supervisión, y (b) a discutir temas multiculturales durante la supervisión. Se proveen recomendaciones para facilitar el desarrollo de supervisión multicultural eficaz.     

Students' Perceptions of Multicultural Training in Counseling Psychology Programs

The Multicultural Competency Checklist (Ponterotto, Alexander, & Grieger, 1995) was used to assess counseling psychology students' perceptions of multicultural training in their programs. Results revealed that most students perceived their programs to (a) have a required multicultural counseling course, (b) employ diverse teaching strategies and procedures, (c) use varied methods of evaluating performance, and (d) have faculty members whose primary research interest was in multicultural issues. Alternatively, many students reported that their programs did not (a) have appropriate representation of bilingual individuals on the faculty, (b) demonstrate adequate leadership and support with regard to multicultural issues, (c) use assessment instruments in evaluating their level of multicultural competency, and (d) make available a “multicultural resource center” for their use. The importance of integrating multicultural issues throughout academic programs is also discussed.     

Cultural Intelligence and Language Competence: Synergistic Effects on Avoidance,Task Performance,and Voice Behaviors in Multicultural Teams

Avoidance of culturally diverse peers undermines the benefits of multicultural teams. Using uncertainty reduction theory, we argue that team members’ cultural intelligence (CQ; the capability to work effectively in culturally diverse settings) and language competence (the ability to communicate in a language) exert main and synergistic effects on avoidance behaviors. We further propose that avoidance negatively predicts individuals’ task performance (behaviors that contribute to team outcomes) and voice behaviors (giving suggestions to improve the status quo). Put together, we test a moderated mediation model where the mediating role of avoidance between CQ and outcomes of task performance and voice behaviors is moderated by language competence. Our results, based on data collected from multicultural team members at three time points, showed no main effects of CQ and language competence on avoidance. Instead, we found synergistic effects such that CQ was negatively related to avoidance only when language competence was high. Avoidance was negatively related to peer-rated task performance and voice behaviors. Conditional process analyses supported our moderated mediation hypothesis, suggesting that avoidance explains why people with higher CQ and higher language competence have higher task performance and voice behaviors.     

How common is sexual attraction towards clients? The experiences of sexual attraction of counselling psychologists toward their clients and its impact on the therapeutic process

This study investigated counselling psychologists' experiences of sexual attraction to their clients. Self-reported incidence of this phenomenon, the reaction that it provokes in therapists, the way they manage their feelings, and the potential impact of their sexual attraction on the therapeutic process, were assessed. On the basis of previous studies of psychotherapists, it was hypothesized that sexual attraction toward clients is common, and that these perceived feelings are not necessarily negative to the therapeutic process or professional relationship; also, it was hypothesized that the disclosure of these feelings to the client could nevertheless lead to a positive therapeutic outcome. Questionnaires were sent to the 286 chartered counselling psychologists included in the British Psychological Society Register. The results showed that significantly more therapists were attracted to at least one client than not. Furthermore, half of the respondents who reported attraction to clients believed that their feelings had a positive impact on the therapeutic process. Therapists who had disclosed their feelings to their clients found significantly more frequently that the impact of their sexual attraction had been positive to the therapeutic process (87.5%), than therapists who did not disclose their sexual attraction (47.1%). The implications of these results for training, supervision and professional issues are discussed.     

Counselor Bilingual Ability,Counselor Ethnicity,Acculturation, and Mexican Americans' Perceived Counselor Credibility

This study examined the effects of counselor bilingual ability and counselor ethnicity on client‐perceived counselor credibility and cultural competence. Participants were assigned to 1 of 4 treatment conditions created by crossing counselor ethnicity with counselor language. No significant differences were found. Regarding rank ordering of the conditions, the European American bilingual counselor was perceived to be more culturally competent than were the Mexican American bilingual counselors. Findings underscore the importance of bilingualism for European American counselors when working with bilingual Mexican American clients.     

Predicting Psychologists' Intentions to Integrate Complementary and Alternative Therapies Into Their Practice

Drawing on an extended Theory of Planned Behaviour (TPB) framework, we employed a cross‐sectional design study to investigate psychologists' intentions to integrate complementary and alternative therapies (CAT) into their practice via recommending CAT to clients or referring clients to CAT practitioners. Participants were registered practicing psychologists from a range of therapeutic orientations (e.g., narrative, cognitive behavioural, psychodynamic). The psychologists were either recruited by phone, following a search of the Internet, or were contacted through their place of employment (hospitals, university counselling service). Those who agreed to participate (N = 122; n = 88 females, n = 34 males) completed a questionnaire that included standard TPB items of attitude, subjective norm, and perceived behavioural control, along with items measuring perceived risk, past behaviour, CAT knowledge, and gender. The outcome variables of interest were (a) intention to recommend CAT to clients and (b) intention to refer clients to CAT practitioners. Structural equation modelling revealed that the extended model was a good fit, explaining 69% (recommending CAT) and 51% (referring to CAT practitioners) of the variance in intentions. For both behaviours, direct paths from attitude and subjective norm to intentions were observed, with perceived risk and past behaviour influencing the TPB predictors of attitudes, subjective norm, and perceived behavioural control. The findings illustrate the role that cognitive and risk factors have on psychologists' decisions to integrate CAT into their practice. Understanding psychologists' cognitions and decisions about CAT integration forms an important basis on which to consider future changes in policy or practice.     

Practitioners’ perspectives on the use of clinical supervision in their therapeutic engagement with asylum seekers and refugee clients

The present study is the first study undertaken in Australia that seeks to explore practitioners’ perspectives on the use of clinical supervision in their therapeutic engagement with asylum seekers and refugees. We used thematic analysis to analyse extracts of interviews that were conducted with nine professionals who worked therapeutically with asylum seekers and refugees and had experience of participating in individual and peer supervision. The findings of the study suggest that supervision encouraged practitioners to develop multicultural awareness and explore therapeutic ways of working that are compatible with their clients’ frame. In addition, supervision provided the context in which practitioners explored the impact of the asylum legislative framework on their clinical work and reflected upon their feelings of powerlessness and political impotence. Implications for practice that derive from supervisory needs of practitioners who work with asylum seekers and refugees are explored.