Racial minority clients’ experiences of sociocultural issues in psychotherapy.

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 The present multilevel-model, direct-comparison meta-analysis of published and unpublished studies confirms that culturally adapted psychotherapy is more effective than unadapted, bona fide psychotherapy by d = 0.32 for primary measures of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.

[Clin Psychol Sci Prac 18: 242–245, 2011] Hall, Hong, Zane, and Meyer present mindfulness and acceptance psychotherapies as promising treatment modalities for Asian Americans, address possible cultural discrepancies, and propose to adapt the diverging elements into culturally syntonic ones. In this commentary, we discuss how the heterogeneity among Asian Americans suggests the existence of a wide variation of individual differences despite group similarities. We point out the importance of cultural accommodation in psychotherapy, where the therapist accommodates for differences in beliefs, values, and norms implied in the existing theory. Finally, we propose that the underlying principle of effective psychotherapy with ethnic and racial minority clients is cultural congruence, or identifying and selecting culturally congruent processes and therapeutic elements by incorporating both cultural and individual variations.

Boundaries are a practice of separating one thing from the other; to make clear where I end and where you begin. Establishing and enforcing clinical boundaries is taken for granted as a necessary foundation of therapeutic work by social work’s governing and administrative bodies. Upon interrogation, normative standards of ethical practice tend to serve broader populations and institutions by deputizing social workers to self-police, even as such boundary norms may fail to serve the individuals and relationships at the heart of clinical practice. As a collective of early-career clinical social workers, we have at times felt certain obligatory boundaries force us to choose between serving an institution and caring for an individual. We explore moments where tension between boundaries and care is felt in vignettes from our clinical work with queer, trans, and racial minority clients, and through our analysis of boundary-setting texts. Seeking to queer norms of boundary-making discourse, we explore the possibilities of resistance that empower clients and prioritize relationships.

The authors discuss the complexities of working with clients with dual minority status (i.e., sexual orientation and ethnicity). The authors explore the multiple contexts that influence ethnic and sexual minority clients' self‐concept. A case illustration of a Puerto Rican lesbian college student is presented, and suggestions for implementing multiple lenses in counseling dual minority clients are offered.

Intimate partner violence against women (IPV) affects all populations, but significant variations among these groups have been suggested. However, research results on racial differences in IPV are not only inconclusive, they are also limited-particularly with regard to racial minorities. As a result, it has been challenging for practitioners and service providers in many communities to serve an increasing number of racial minority clients. This study used the Collaborative Psychiatric Epidemiology Surveys (CPES) to examine differences in the prevalence of IPV, and associated factors, among major race groups in the U.S. Included variables were age, race, financial security, employment, education, social network, IPV perpetration and victimization, and severity of IPV. The results showed that Blacks were victimized the most, followed by Whites and Latinos, and Asians were victimized the least. Asians were the least likely to be victimized by IPV, even when controlling for sociodemographic variables. The odds of victimization for Blacks and Latinos were not significantly different from Whites. Financial security and age affected IPV victimization. Those who perceived themselves as financially secure were less likely to be victimized than those who did not. The older were less likely to be victimized than the younger. Employment, education, and social networks did not affect victimization. Race was not a significant predictor of perpetration, when controlling for other variables. Age was the only predictor of perpetration: the older were less likely to perpetrate IPV than the younger.

Chapter sixteen - Addiction Treatment Disparities: Ethnic and Sexual Minority Populations

The purposes of this study were to (a) investigate whether psychotherapists differ in their effectiveness with clients, (b) determine whether disparities exist within therapists' caseloads in their outcomes with White and racial and ethnic minority (REM) clients, (c) explore therapist factors that might contribute to observed therapist effects, and (d) identify whether treatment outcomes varied for REM and White clients. A sample of 3,825 clients seen by 251 therapists at 45 college counseling centers completed the Counseling Center Assessment of Psychological Symptoms at the beginning and end of individual psychotherapy. Therapists differed in their effectiveness at reducing general distress across clients, and evidence was found for disparities within therapists' caseloads in their effectiveness with REM and White clients. Effect sizes were small. Disparities within therapists' caseloads were not a function of any therapist variable that was studied. Therapy outcomes were similar for White and REM clients. Therapist multicultural competence can, and should, be considered in terms of measurable outcomes across client racial/ethnic groups. It is possible to identify multiculturally expert therapists who evidence competence with both REM and White clients and who might serve as models from whom the field could learn.

Concerns about Counseling Racial Minority Clients Scale

Concerns about counseling racial minority clients: Ethnocultural empathy, insight, and multicultural intervention self-efficacy.

Concerns About Counseling Racial Minority Clients and Multicultural Counseling Self-Efficacy

Applying Theater-Based Training Methods to Address Anti-Black Racism in Community-Based Mental Health Services: A Pilot Feasibility Study

The purpose of this study was to develop and validate the Concerns about Counseling Racial Minority Clients (CCRMC) scale among counselor trainees. Sample 1 was used for an exploratory factor analysis and confirmatory factor analysis. Four factors were identified, Managing Cultural Differences (α = .82), Offending or Hurting Clients (α = .87), Biased Thoughts and Behaviors (α = .81), and Client Perceptions (α = .77). The coefficient alpha for the CCRMC was .90. The results support the validity of the scale. The scores on the CCRMC and its subscales have positive associations with fear of negative evaluation from others (r = .19 to .40) and negative associations with general counseling self-efficacy (r = -.30 to -.46) and multicultural intervention self-efficacy (r = -.30 to -.64). The CCRMC significantly predicted fear of negative evaluation, session management self-efficacy, and multicultural intervention self-efficacy over and above multicultural social desirability. The validity evidence was not different between White and minority graduate trainees. In Sample 2, the estimated 1-week test-retest reliabilities ranged from .75 to .96 for the CCRMC and its four subscales.

One hundred five counselor trainees were surveyed to determine their attitudes toward ethnic and non-ethnic minorities. The findings suggested that these counseling students hold positive attitudes toward ethnic minorities, somewhat negative attitudes toward gays and lesbians, and moral development levels typical of college populations. Multiple regression analyses found that the level of moral development was positively related to attitudes toward gays and lesbians, but not toward ethnics. As compared to counselor trainees surveyed one decade earlier (McDermott & Stadler, 1988), these trainees exhibited less homophobia. The relationship of moral development and attitudes toward ethnic minorities was also found to have diminished.

One hundred and twenty counseling students representing 10 programs across the United States were administered the Purdue Master Attitude Scale, the Defining Issues Test, the Index of Homophobia and a demographic questionnaire in an effort to identify attitudes of students to ward minority groups. A demographic profile of these counselors in traning presents a picture of the ‘typical’ American. They are fairly young, mostly caucasian, middle class and were raised in traditional two-parent families. The results of the instruments administered indicate that counseling students appear to reflect the dominant culture attitude with respect to homophobia by demonstrating average to high homophobia, while the Purdue Master Attitude Scale reflects a somewhat overall positive attitude toward ethnic minorities. In terms of statistical analyses, level of moral judgment, as measured by the Defining Issues Test, was significantly related to attitude to ward ethnic and sexual preference minorities. Individuals with more favorable attitudes demonstrated higher levels of moral reasoning and vice versa. Higher frequency of experience with minorities was significantly related to lower homophobia scores and demonstrated a trend in the direction of better attitude scores. Quality of experience, while not achieving significance, showed a trend with better quality ratings being related to better attitude toward ethnic minorities and lower homophobia scores.

A now well-established link exists between passive representation of racial and gender minorities in certain bureaucracies and substantive benefits for the represented groups. However, few quantitative studies have distinguished between the multiple possible mechanisms by which passive representation might produce such effects. We conduct a novel set of empirical analyses aimed at determining whether or not passive representation produces effects only for those clients who directly interact with bureaucrats who share their demographic characteristics or if passive representation produces broader organizational-level effects. We find strong evidence that minority clients’ outcomes are positively associated with representation in portions of the bureaucracy with which they do not directly interact. This suggests that either passive representation produces substantial bottom-up, organizational-level effects or that managers who recruit minority personnel also adopt policies that are favorable toward minority clients.