Reaching Latino Families Through Pediatric Primary Care: Outcomes of the CANNE Parent Training Program

The lack of culturally adapted parenting programs for Latinos contributes to low engagement in effective parenting programs. Criando a Nuestros Niños Hacio el Éxito (CANNE), a culturally adapted program, improves family dynamics by decreasing problematic child behavior and helping parents manage stress. CANNE was delivered with 12 Latino parents of children (age 3–7). Increased attendance and participation resulted in less child behavior problems and parenting stress from preintervention to postintervention. A culturally relevant adaptation of an evidence-based parenting program improved engagement, child behavioral outcomes, and parenting stress. Implications of mental health services in primary care facilities for Latino families are addressed.     

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.     

Therapeutic strategies for Mexican-American families

This paper emphasizes the need for therapists to develop culturally attuned approaches to families. Family therapy strategies effective with families of Mexican descent are related to specific stages of the treatment process. Categories of problems presented by Mexican-American families are defined and corresponding therapist roles suggested. A specific class of interventions, labeledcultural strategies, makes use of culture in the service of therapy. Although the illustrations presented are of Mexican-American families, the concepts can be adapted to other ethnic families.     

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.     

Understanding Familial/Cultural Factors in Adolescent Depression: A Culturally-Competent Treatment for Working With Chinese American Families

A significant challenge for researchers and clinicians is in the process of determining culturally sensitive strategies to ensure treatment effectiveness with ethnic populations in the United States. This article highlights key aspects of treating Chinese American families where a child is struggling with adolescent depression. Relevant literatures associated with adolescent depression and effective treatment of Chinese Americans are reviewed and organized according to the dimensions of therapist knowledge, awareness, and skills. Therapist guidelines are provided using key aspects of cognitive behavioral therapy. Additional suggestions are presented for culturally competent therapy with Chinese American youth and their families.     

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.     

Adaptation of CBT for Traumatized South African Indigenous Groups: Examples from Multiplex CBT for PTSD

This article describes how Culturally Adapted Multiplex CBT, a treatment that emphasizes somatic processing and emotion regulation, was adapted for a traumatized South African indigenous group, the Sepedi. A model of psychopathology is presented, the Multiplex Model of Trauma-Related Disorder, which depicts the processes that generate multiple comorbidities and prominent somatization in minority, refugee, and other non-Western populations. The nine dimensions of Culturally Adapted Multiplex CBT are discussed, and so too the “cultural adaptation diamond.” Concepts such as “explanatory model bridging” are presented. A culturally sensitive assessment measure of local somatic complaints and cultural syndromes (the Sepedi Symptom and Syndrome Addendum, or Sepedi SSA) is detailed, as well as how CBT techniques were implemented with this group—for example, modification of culturally specific catastrophic cognitions, doing exposure (e.g., interoceptive exposure), teaching attentional control and mindfulness techniques, and teaching “loving kindness.” Case examples with clinical outcomes are provided to further illustrate how Multiplex CBT was adapted for the South African indigenous group.     

Ethnocultural considerations in group psychotherapy.

The increasingly heterogeneous populations of the industrialized countries necessitate a reappraisal of the sociocultural norms and group-therapeutic approaches that were based primarily on White Judeo-Christian values. This author reviews the literature on the treatment of ethnically different patients and discusses socio-cultural phenomena relevant to group therapy that differ from the mainstream culture. The culturally determined contrasts in perception, attitude, communication, and behavior, which minority members may exhibit in the group, are examined. The specific demands on the therapist working with ethnic group members are highlighted along with the modifications in therapeutic technique. Recommendations for a culturally sensitive and broader training of group therapists are offered.     

Making Sense of Climate Change: How Story Frames Shape Cognition

In 2006, Adam J. Berinsky and Donald R. Kinder published findings in the Journal of Politics that demonstrated that framing news as a story influences how individuals cognitively organize concepts and information. The study presented here moves forward in this tradition. This research combines samples obtained in the springs of 2009 and 2010 while conducting online experiments. In these experiments, slightly over 2,000 respondents are asked to organize concepts presented in one of three culturally nuanced stories about climate change or where information is presented as a list. Hierarchical cluster analysis indicates that when respondents are exposed to culturally congruent stories, respondent organizational patterns are more likely to mirror the story. We discuss the implications of these findings.     

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.     

Aboriginal Practitioners Offer Culturally Safe and Responsive CBT: Response to Commentaries

We appreciate the valuable commentaries that have been provided for our paper “Can CBT be effective for Aboriginal Australians? Perspectives of Aboriginal practitioners trained in CBT.” The international authors identify how CBT, with adaptations by culturally responsive practitioners can be of value for non‐Western and Indigenous peoples. The commentary by Australian psychologists Dudgeon and Kelly questions the value of CBT for Indigenous Australians, terming it a “Western therapy” that is “culturally unresponsive” and “culturally blind.” They also critique the methodology of the study. We argue that CBT can be adapted by culturally competent practitioners to be culturally safe in Australia, as elsewhere. Cultural safety is mostly a function of the therapist, not the therapy. In the Bennett‐Levy et al. (2014) study, CBT was delivered in a culturally responsive way by Aboriginal counsellors within their own communities. CBT is a particularly adaptable and versatile therapy, and embodies principles of empowerment and self‐determination that are central to Indigenous social and emotional well‐being. We are concerned that CBT, which has strong empirical support and has been adapted elsewhere for a range of cultures, including Indigenous cultures, may be being denied to Indigenous Australian clients. There is considerable opportunity to evaluate the effectiveness and versatility of CBT, and variations of its mode of delivery, for all Australians.     

A culturally sensitive approach to therapy with immigrant families: the case of Jewish emigrants from the former Soviet Union

This article is based on accumulated clinical experience in Israel with families that emigrated from the former Soviet Union. It describes a culturally sensitive systemic intervention with two such families: a single-parent family, and a family that exhibited physical violence. Relevant cultural characteristics of family patterns and parent-child relationships in Jewish-Soviet families are reviewed. It is demonstrated how a cross-cultural perspective may affect the interpretation of presented problems and result in a less pathological perspective. It is further illustrated how universal intervention techniques combined with culturally sensitive approaches may produce positive effects in therapy.     

Living,resisting, and playing the part of athlete: Narrative tensions in elite sport

ObjectivesTo explore: (i) How elite and professional sport culture might steer individuals towards particular stories, identities, and actions; (ii) How athletes navigate or respond to these cultural pressures.DesignCross-sectional qualitative methodology.MethodNarrative interviews and focus groups with 21 elite and professional athletes followed by a narrative analysis of structure and form.ResultsAthletes demonstrated one of three processes. Individuals who live the part of athlete story their life and act in ways that conform to a culturally dominant performance narrative. Here, identity is foreclosed, relationships sacrificed in the pursuit of success, and long-term wellbeing threatened. Over time, alternative narrative types may provoke moral reflection on their story and actions. Individuals who resist the part of athlete sustain a life story and identity that deviates from the performance narrative, drawing on alternative narrative types. Their resistance is typically overt as they publicly demonstrate actions that align with their multidimensional story. Individuals who play the part of athlete modify their story and actions depending on sociocultural context. These individuals covertly maintain a multidimensional life story, but silence this story when powerful others require performance stories.ConclusionsAlthough some elite/professional athletes' life stories revolve around performance outcomes, this is not a prerequisite for excellence. Other athletes achieve excellence while sustaining a multidimensional life story and identity. To do so, they navigate a culture that expects a performance focus, through overt resistance or covertly manipulating their public stories and actions.     

Semiotic Regulation in the Construction of Maternal Bond: From Body Experience to the Semiotic Field

The objective of this paper is to analyze how the maternal bond in first-time pregnant women emerges from bodily experiences in the pre-semiotic level and leads to the emergence of the semiotic field. The bond as a sign field is internally structured and enables the regulation of connections with other signs outside the field. As a result of the dialogue between biological and sociocultural imperatives, sociocultural meanings are turned into personal meanings and presented by women through behavior. This study is based on longitudinally-collected interview data consisting of six interviews with women from the time they were pregnant until their child turned one year old. During this period, three ruptures as turning points in the formation of the bond were identified. Based on idiographic analyses, it was concluded that body signals caused by the development of the fetus are coded by women into signs of various kinds, which define the status of mother and create the foundation for the mother-child relationship which continues throughout the lifespan.     

Adaptation of CBT for Traumatized Egyptians: Examples from Culturally Adapted CBT (CA-CBT)

In this article we illustrate how CBT can be adapted to a traumatized Egyptian population with Islamic beliefs, giving examples from our adaptation of Culturally Adapted–CBT (CA-CBT) for this cultural group. We discuss a culturally sensitive assessment measure of local somatic complaints and cultural syndromes that was devised based on clinical experience with traumatized Egyptians. We also demonstrate how to normalize symptoms, create positive expectancy about the treatment, and educate about trauma. We give examples of how mindfulness can be adapted for an Egyptian Islamic population, and we describe local religious strategies, such as dhikr (religious chanting), salah (ritualistic prayer), and dua (supplication), that may be used to promote attentional shift from rumination topics and to teach attentional control. We describe how “loving kindness” can be adapted for this group. We outline how to modify culturally generated catastrophic cognitions and how to conduct interoceptive exposure and to create positive re-associations in a culturally sensitive manner. We describe how worry themes are explored and addressed based on a heuristic panic attack–PTSD model; how to teach anger management in a culturally sensitive way; and how to address sleep-related problems in this population. We suggest using cultural transitional “rituals” at the end of the treatment to give patients a sense of closure and a positive feeling of transformation. A case example is presented to illustrate cultural challenges associated with delivering CA-CBT to an Egyptian population. We introduce certain concepts such as cultural grounding and explanatory model bridging, both therapeutic techniques that increase adherence, positive expectancy, and cultural consonance.     

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.     

Effects of discrete emotions on young children's suggestibility

Two experiments investigated the effects of sadness, anger, and happiness on 4- to 6-year-old children's memory and suggestibility concerning story events. In Experiment 1, children were presented with 3 interactive stories on a video monitor. The stories included protagonists who wanted to give the child a prize. After each story, the child completed a task to try to win the prize. The outcome of the child's effort was manipulated in order to elicit sadness, anger, or happiness. Children's emotions did not affect story recall, but children were more vulnerable to misleading questions about the stories when sad than when angry or happy. In Experiment 2, a story was presented and emotions were elicited using an autobiographical recall task. Children responded to misleading questions and then recalled the story for a different interviewer. Again, children's emotions did not affect the amount of story information recalled correctly, but sad children incorporated more information from misleading questions during recall than did angry or happy children. Sad children's greater suggestibility is discussed in terms of the differing problem-solving strategies associated with discrete emotions.     

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.     

Socialization and cognition in children between the age of 18 and 24 months

A cross-cultural study of mother–child dyads was set up to test the hypothesis that sociocultural differences, mediated by variations of maternal intervention, influence the way in which the child manipulates objects and, thereby, his cognitive and social competences. Two series of observations were conducted with three groups of children aged 18–24 months (15 from the American middle class, 15 from French families and 15 from North African families—the last two groups both underprivileged): (a) ‘naturalistic’ observations of two systems of interaction (child–mother and child–children interaction) showed that each child is characterized by one type of object manipulation (protected, induced, activated or autonomous) and that maternal intervention varies with the sociocultural background; assessment of the child's behavioural sequences unravelled his strategies for solving and avoiding conflicts with his peers; (b) observations of the child with a standardized material permitted an evaluation of his cognitive competences for spontaneous problem-solving. Regarding the assumptions of our hypothesis, the results furnish the following conclusions: (1) social and cognitive competences are related to the object manipulation type. In all samples, children characterized by ‘activated’ and ‘autonomous’ manipulation obtain the better results; (2) maternal intervention differs among the samples depending on the sociocultural background; these differences (limitation and physical contact) do not correspond to differences in types of manipulation; (3) type of manipulation is an interactive construction; it characterizes the functioning of the mother–child dyad and its prevailing dynamics between permanence and change. ©1997 by John Wiley & Sons, Ltd.