Cultural Diversity: Do We Need a New Wake-Up Call for Parent Training?

In 1996, Forehand and Kotchick concluded that parent-training (PT) interventions largely ignored cultural influences on parenting behavior. They reasoned that the failure to integrate the influence of ethnicity into theories of parenting behavior could result in culturally biased and less effective interventions. The present article addresses whether their “wake-up call” went unheard. We review research on PT treatment studies and examine (a) the rate of inclusion of ethnic minority parents in PT research, (b) the effectiveness of PT across ethnic groups, and (c) the effectiveness of culturally adapted PT interventions. Results show that there has been an increase in the ethnic diversity of PT treatment studies over the past three decades, yet only one methodologically sound study directly examined ethnicity as a moderator of PT treatment outcome. Despite the paucity of evidence that ethnicity is a moderator of parent-training outcomes, a number of culturally adapted PT treatments have been developed. These adapted interventions have rarely been tested against the unadapted interventions on which they are based. The results fail to support the current emphasis on ethnicity in efforts to improve the effectiveness of PT. We present methodological and conceptual limitations in the existing literature and provide recommendations for researchers studying the effects of ethnicity on PT outcomes.     

The psychotherapy adaptation and modification framework: application to Asian Americans

Although effective treatments for many mental disorders have been developed, little research has been conducted to determine whether these interventions are effective in treating those from diverse backgrounds. Recent reports have suggested that ethnic minorities are less likely to receive quality health services and that they evidence worse treatment outcomes when compared with other groups. To improve care for those from diverse backgrounds, Western-developed psychotherapies may need to be culturally modified or adapted to become more effective in treating ethnic minorities. This article addresses the need for adapting psychotherapy and provides a conceptual framework for making such modifications. The psychotherapy adaptation and modification framework model is applied to recent Asian American immigrants as an illustrative example. However, it may also serve as a point of departure to adapt therapies for other ethnocultural groups.     

The cultural theory and model of suicide

A growing body of research has demonstrated important variations in the prevalence, nature, and correlates of suicide across ethnic and sexual minority groups. Despite these developments, existing clinical and research approaches to suicide assessment and prevention have not incorporated cultural variations in any systematic way. In addition, theoretical models of suicide have been largely devoid of cultural influence. The current report presents a comprehensive analysis of literature describing the relationship between cultural factors and suicide in three major ethnic groups (African Americans, Asian Americans, and Latinos) and LGBTQ¹ sexual minority groups. We utilized an inductive approach to synthesize this variegated body of research into four factors that account for 95% of existing culturally specific risk data: cultural sanctions, idioms of distress, minority stress, and social discord. These four cultural factors are then integrated into a theoretical framework: the Cultural Model of Suicide. Three theoretical principles emerge: (1) culture affects the types of stressors that lead to suicide; (2) cultural meanings associated with stressors and suicide affect the development of suicidal tendencies, one's threshold of tolerance for psychological pain, and subsequent suicidal acts; and (3) culture affects how suicidal thoughts, intent, plans, and attempts are expressed. The Cultural Model of Suicide provides an empirically guided cohesive approach that can inform culturally competent suicide assessment and prevention efforts in future research and clinical practice. Including both ethnic and sexual minorities in our investigations ensures advancement along a multiple identities perspective.     

Culturally adapting an evidence-based parenting intervention for Latino immigrants: the need to integrate fidelity and cultural relevance

Latinos constitute the largest ethnic minority group in the United States. However, the cultural adaptation and dissemination of evidence-based parenting interventions among Latino populations continues to be scarce despite extensive research that demonstrates the long-term positive effects of these interventions. The purpose of this article is threefold: (1) justify the importance of cultural adaptation research as a key strategy to disseminate efficacious interventions among Latinos, (2) describe the initial steps of a program of prevention research with Latino immigrants aimed at culturally adapting an evidence-based intervention informed by parent management training principles, and (3) discuss implications for advancing cultural adaptation prevention practice and research, based on the initial feasibility and cultural acceptability findings of the current investigation.     

Cultural competence and evidence-based practice in mental health services: a complementary perspective

The need for cultural competence and the need for evidence-based practice in mental health services are major issues in contemporary discourse, especially in the psychological treatment of people of color. Although these 2 paradigms are complementary in nature, there is little cross-fertilization in the psychological literature. The present article illustrates the complementary nature of these 2 paradigms. A main point of convergence is related to the development of culturally adapted interventions in the move from efficacy research to effectiveness studies. The implications of cultural adaptations of empirically supported treatments for mental health services in terms of research and practice with ethnic/racial minority populations are discussed.     

Culturally Sensitive AIDS Educational Videos for African American Audiences: Effects of Source, Message, Receiver, and Context

The importance of using culturally sensitive educational materials in HIV-related interventions with racial and ethnic minority groups is widely recognized. However, little empirical research has been conducted to assess the relative effectiveness of different techniques for creating culturally sensitive AIDS educational videos. Two field experiments with three samples of African American adults (N = 174, 173, and 143) were conducted to assess how source characteristics (race of communicator), message characteristics (multicultural message vs. culturally specific message), and audience characteristics (racial distrust and AIDS-related distrust) influence proximate (perceptions of the message's credibility and attractiveness) and distal (AIDS-related attitudes, beliefs, and behavioral intentions) output variables for AIDS educational videos. In Study 1, an AIDS video with a culturally specific message was rated as more credible, more attractive, and of higher quality than was a video with a multicultural message. The multicultural message was rated less favorably when delivered by a White announcer than when the announcer was Black. In Study 2, the same pattern was replicated with a second community sample and a campus-based sample. Study 2 also indicated that a multicultural message might be more effective if delivered in a culturally specific context, namely, after audience members watch a culturally specific video. Minimal changes were observed in distal outcome variables. It is argued that influencing proximate output variables is necessary, though not sufficient, for effecting long-term change in AIDS-related attitudes, beliefs, and behaviors.     

Integration of Cognitive-Behavioral and Interpersonal Therapies for Latinos: An Argument for Technical Eclecticism

The integration of psychotherapeutic techniques is a common practice among today's clinicians. However, most discussions on psychotherapy integration have focused on general theoretical issues without attention to special populations. Latinos now represent the largest ethnic minority population in the United States and the mental health needs of this population are increasing. Although there are few controlled outcome studies that focus on Latinos, basic research suggests that integrating components of interpersonal therapy (IPT) into cognitive-behavioral therapy (CBT) may be particularly effective with this population. Specific suggestions for integrating CBT and IPT techniques are presented, and ways in which this integration can be adapted in a culturally sensitive manner are reviewed. An ethical and culturally sensitive CBT-IPT integration for Latinos requires empirical verification. Future studies on CBT-IPT synthesis should demonstrate the effectiveness of such integration relative to CBT or IPT alone.     

Culturally Sensitive Therapy with Low-Income Ethnic Minority Clients: An Empowering Intervention

In this article the author discusses how to engage low-income ethnic minority clients in psychotherapy. She proposes the empowering model of clinical intervention, which views clients and their difficulties in the context of their cultural identities, and social backgrounds and intervenes within a framework that is ecological and empowering. Further, clinicians need to clearly identify clients’ abilities and cultural needs in order to accurately assess and utilize their strengths and resources. The empowering model of clinical intervention is described as culturally sensitive and ecologically valid. The model provides a structured and predictable format that maintains client safety and control while addressing the challenges of race, class, sexual orientation, and other client differences.     

Culturally adapted psychotherapy and the legitimacy of myth: a direct-comparison meta-analysis

Psychotherapy is a culturally encapsulated healing practice that is created from and dedicated to specific cultural contexts (Frank & Frank, 1993; Wampold, 2007; Wrenn, 1962). Consequently, conventional psychotherapy is a practice most suitable for dominant cultural groups within North America and Western Europe but may be culturally incongruent with the values and worldviews of ethnic and racial minority groups (e.g., D. W. Sue, Arredondo, & McDavis, 1992). Culturally adapted psychotherapy has been reported in a previous meta-analysis as more effective for ethnic and racial minorities than a set of heterogeneous control conditions (Griner & Smith, 2006), but the relative efficacy of culturally adapted psychotherapy versus unadapted, bona fide psychotherapy remains unestablished. Furthermore, one particular form of adaptation involving the explanation of illness-known in an anthropological context as the illness myth of universal healing practices (Frank & Frank, 1993)-may be responsible for the differences in outcomes between adapted and unadapted treatments for ethnic and racial minority clients. The present multilevel-model, direct-comparison meta-analysis of published and unpublished studies confirms that culturally adapted psychotherapy is more effective than unadapted, bona fide psychotherapy by d = 0.32 for primary measures of psychological functioning. Adaptation of the illness myth was the sole moderator of superior outcomes via culturally adapted psychotherapy (d = 0.21). Implications of myth adaptation in culturally adapted psychotherapy for future research, training, and practice are discussed.     

Psychocultural Profiles of Asian and Pacific Islander Americans: Implications for Counseling and Psychotherapy

This article introduces Asian and Pacific Islander Americans as disparate groups of various ethnic and cultural backgrounds. From the perspective of culturally prescribed norms, standards, and values that affect the acculturation experiences and lifestyles of this ethnic minority group, some psychocultural profiles are presented. The relevant implications for counseling and psychotherapy are also suggested.     

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.     

In search of cultural diversity: recent literature in cross-cultural and ethnic minority psychology

The purpose of this study was to identify where the most work on cross-cultural and ethnic minority psychology is being published and who the most productive authors are. The journals that published the most articles on cross-cultural and ethnic minority issues from 1993 to 1999 and the most prolific authors on these issues were identified by PsycINFO. Cross-cultural research is cross-national, whereas ethnic minority research involves groups of color within the United States. The citation impact of these journals and authors was determined from the 1997 Social Sciences Citation Index. The results suggest that there is very limited overlap between the literatures in cross-cultural and ethnic minority psychology. Most of the research in these areas is published in specialty journals, and there is a paucity of this research in prestigious journals. Perceived or actual barriers to publication in prestigious journals may cause some to seek specialty journals as outlets for research on cultural diversity. The top scholars in cross-cultural psychology are primarily men of European ancestry, whereas most of the top scholars in ethnic minority psychology are ethnic minority men and women. Strategies to increase the prominence of cultural diversity in the psychology literature include combining cross-cultural and ethnic minority psychology, increasing the number of editorial board members of prestigious journals having expertise in cultural diversity, and increasing the quality of specialty journals. Psychology will remain ill-equipped to face the challenges of the new millennium without increased attention to cultural diversity.     

Science, ethnicity, and bias: where have we gone wrong?

The quality, quantity, and funding of ethnic minority research have been inadequate. One factor that has contributed to this inadequacy is the practice of scientific psychology. Although principles of psychological science involve internal and external validity, in practice psychology emphasizes internal validity in research studies. Because many psychological principles and measures have not been cross-validated with different populations, those conducting ethnic minority research often have a more difficult time demonstrating rigorous internal validity. Thus, psychology's overemphasis of internal as opposed to external validity has differentially hindered the development of ethnic minority research. To develop stronger research knowledge on ethnic minority groups, it is important that (a) all research studies address external validity issues and explicitly specify the populations to which the findings are applicable; (b) different research approaches, including the use of qualitative and ethnographic methods, be appreciated; and (c) the psychological meaning of ethnicity or race be examined in ethnic comparisons.     

Psychosocial treatment research with ethnic minority populations: ethical considerations in conducting clinical trials

Because of historical mistreatment of ethnic minorities by research and medical institutions, it is particularly important for researchers to be mindful of ethical issues that arise when conducting research with ethnic minority populations. In this article, we focus on the ethical issues related to the inclusion of ethnic minorities in clinical trials of psychosocial treatments. We highlight 2 factors, skepticism and mistrust by ethnic minorities about research and current inequities in the mental health care system, that researchers should consider when developing psychosocial interventions studies that include ethnic minorities.     

Cognitive-Behavioral Therapy for Depression in an Older Gay Man: A Clinical Case Study

Although strong evidence supports cognitive-behavioral therapy for late-life depression and depression in racial and ethnic minorities, there are no empirical studies on the treatment of depression in older sexual minorities. Three distinct literatures were tapped to create a depression treatment protocol for an older gay male. Interventions were deduced from the late-life depression literature, culturally adapted CBT protocols for racial minorities, and the emerging social and developmental psychological theories for lesbian, gay, and bisexual populations. Specific treatment interventions, processes, and outcomes are described to illustrate how these literatures may be used to provide more culturally appropriate and effective health care for the growing, older sexual minority population.     

Culturally Competent Family Interventions: Review and Case Illustrations

Family therapy is often the treatment of choice for culturally diverse clients. This article provides a critical review of culturally competent assessment and intervention strategies for use with ethnic minority families in the U.S. A culturally informed view of the definition of family health and dysfunction is presented, basic structure and goals of family therapy are delineated, and family therapy process and techniques are addressed. Clinical vignettes are provided to illustrate critical points.     

Cultural considerations in adolescent suicide prevention and psychosocial treatment

Ethnic groups differ in rates of suicidal behaviors among youths, the context within which suicidal behavior occurs (e.g., different precipitants, vulnerability and protective factors, and reactions to suicidal behaviors), and patterns of help-seeking. In this article, the authors discuss the cultural context of suicidal behavior among African American, American Indian and Alaska Native, Asian American and Pacific Islander, and Latino adolescents, and the implications of these contexts for suicide prevention and treatment. Several cross-cutting issues are discussed, including acculturative stress and protective factors within cultures; the roles of religion and spirituality and the family in culturally sensitive interventions; different manifestations and interpretations of distress in different cultures; and the impact of stigma and cultural distrust on help-seeking. The needs for culturally sensitive and community- based interventions are discussed, along with future opportunities for research in intervention development and evaluation.     

The Ethnic Context of Child and Adolescent Problem Behavior: Implications for Child and Family Interventions

This article links the empirical literature on race and ethnicity in developmental psychopathology with interventions designed to reduce adolescent problem behavior. We present a conceptual framework in which culture is endogenous to the socialization of youth and the development of specific self-regulatory strategies. The importance of cultural influence is identified at three levels: (a) intrapersonal developmental processes (e.g., ethnic identity development, development of coping modifies mechanisms and self-regulatory mechanisms), (b) family socialization processes (e.g., racial and ethnic socialization), and (c) interaction with larger societal contexts (e.g., maintenance of bicultural competence in adapting to mainstream and ethnic cultures). We discuss limitations of current assessment and intervention practices that focus on reducing adolescent problem behavior with respect to the cultural issues identified above. We propose that empirically supported adaptive and tailored interventions for adolescent problem behavior are optimal for serving multicultural children and families. To empower such interventions to better serve children and families of color, it is essential that assessments that guide the adaptation and tailoring process include culturally salient dynamics such as ethnic identity, racial socialization, and culturally informed parenting practices. This work is supported by an NRSA grant to the first author, and the following for the second author: grants DA07031, DA13773, and DA16110 from the National Institute on Drug Abuse.     

The Role of Religion in Therapy: Time for Psychologists to Have a Little Faith?

The argument has been made that religious and spiritual (R/S) forms of treatment, or R/S adaptations of existing treatments, are an appropriate, culturally sensitive, and potentially efficacious method of intervention when working clinically with religious patients experiencing psychological, behavioral, or physiological dysfunction. The previous articles in this special series describe four such interventions designed for use with patients with particular presenting problems including serious mental illness, cancer, eating disorders, and scrupulosity. This article offers a brief historical presentation on the growth of interest in R/S in clinical psychology and behavioral medicine, with particular attention to the general issue of the role of values in therapy, and includes criticisms of integrating R/S in treatment. The difficulty of appreciating unique R/S perspectives and their relevance for particular clients is emphasized and the question of whether a “true” understanding of R/S beliefs necessarily leads to better health is examined. Each of the four therapies presented in this special series is individually analyzed, and it is clear that they offer sensitive and culturally relevant approaches to treating the various disorders, though areas of potential improvement or possible confusion are highlighted. Finally, the following are deemed essential if R/S-informed therapies are to impact the field and be appropriately introduced with clients: (a) training of future and current practitioners; (b) longitudinal research on R/S; (c) outcome studies of R/S interventions; and (d) adequate funding for the achievement of these goals.     

Culturally Adapted Psychosocial Interventions for Schizophrenia: A Review

Recent research examining the potential efficacy of culturally adapted interventions for various mental disorders illustrates increasing interest in the integration of cultural perspectives into mental health systems. Despite recent evidence demonstrating that culturally adapted interventions may be more effective than a one-size-fits-all approach, few psychosocial treatments for schizophrenia consider cultural factors that may enhance their efficacy with diverse populations. The aim of this review is to discuss the empirical evidence examining the potential utility of culturally adapted group interventions for schizophrenia, as a means to encourage further work and expansion in this area. Specifically, this article provides an in-depth review of the empirical literature on culturally adapted psychosocial interventions for individuals with schizophrenia and their family members, with a focus on group-based interventions. This review is followed by a discussion of a few cultural constructs that may impact patient and family member functioning, and therefore may be important to address in psychosocial treatments for schizophrenia. Finally, we end this review with a broad discussion of research limitations and potential areas for additional research, clinical implications for adapting EBTs to better address cultural concerns, and a case vignette to illustrate how cultural considerations can be integrated into a traditional multifamily group therapy approach.