Cross-cultural Clinical Practice Research Articles

Cross-Cultural Adaptation and Psychometric Properties of the Greek Vineland Adaptive Behavior Scales, Second Edition: Parent/Caregiver Rating Form (VABS II-Gr)

Background: Vineland adaptive behavior scales-parent/caregiver rating form (VABS II) is a questionnaire used to examine adaptive behavior in individuals, whose age ranges from birth to 90 years old. The purpose of this study was to translate and assess the psychometric properties of the Greek version VABS II-parents/caregiver, in children. Method: Three samples of participants within the ages 5 - 10 years were analyzed; including two groups of developmental disorders (N = 116) and control group (N = 90). The questionnaire was translated into Greek by two bilingual translators. The pre-final version was pilot tested in 30 mothers of typical and atypical development children, aged 3 - 10 years. The final version was submitted in 206 subjects, twice, in different ways for reliability testing. A split-half reliability test was employed for the reliability of scores for two halves of the test, to evaluate the reliability and internal consistency, of the VABS II-Gr. The spearman-brown formula was used to determine correlations between the domains. Α known-group method was utilized, to estimate construct validity, exploring the differences between the two groups. Results: Across the age groups, overall, the domain reliability estimates are quite high, with a value of .83 to .95. Equivalence reliability (correlation) was found to be excellent (r = .90). Conclusion: The Greek version of VABS-II is an appropriate scale for assessing adaptive behaviors in a Greek context, as it meets the standard of the original version of VABS. This scale was found to be acceptable, understandable, valid and reliable by Greek parents and may thus be used in cross-cultural clinical practice and research.

The Invisibility of Whiteness in Clinical Practice: Case Commentary on “Becoming Visible: The Case of Colette”

My critical analysis of “Becoming Visible: The Case of Colette” is informed by Lee and Bhuyan’s (Soc Serv Rev 87:98–130, 2013) approach to analyze cross-cultural clinical practice. It examines “invisible” discursive moments that functionally reproduce sociocultural power dynamics of discrimination and oppression within the clinical encounter. I explored several threads of the therapy narrative to make visible privileged identities and ideologies, such as the normative performance of whiteness. In addition, my commentary demonstrates alternative narratives that resituate clinical practice to a more antidiscriminatory, antioppressive space through “de-centering” and making visible the discourse of whiteness (Lee and Bhuyan in Soc Serv Rev 87(1):98–130, 2013).

Blending Western Biomedicine with Local Healing Practices.

Western allopathic physicians working internationally might encounter allopathic colleagues who endorse local healing practices that are not scientifically supported and, hence, might pose harm to patients. Respect for the autonomy of local physicians and patients thus can conflict with the ethical principles of beneficence and nonmaleficence. In such a situation, it is advisable for Western allopathic physicians to communicate their concerns to local colleagues as equal partners. Making an effort to understand local meanings associated with a traditional therapy demonstrates one's respect for local cultural ideas and practices, even if one disagrees with that therapy, and is crucial to tailoring messages about clinical practice change. A realistic approach to cross-cultural clinical practice change seeks to reduce, rather than eliminate, harm.

How a Therapist Responds to Cultural Versus Noncultural Dialogue in Cross-Cultural Clinical Practice

A therapist's capacity to respond appropriately to a client is crucial in fostering positive therapeutic relationships and outcomes in general but it is even more important in cross-cultural therapy. Given the clinical significance of the dyad-specific and dynamic nature of the therapist's responsiveness, our study explores one white female therapist's responsiveness with three racial/ethnic minority clients in the beginning phase of therapy sessions. Using the structural analysis of social behavior and conversation analysis, the turn-by-turn intensive analysis of culturally relevant and nonrelevant talk in therapy illustrates how a therapist, who is appropriately and positively responsive to clients in other contexts, becomes disengaged and even negatively oriented during culturally relevant talk. This finding illustrates the challenges involved in maintaining positive engagement and responsiveness in cross-cultural therapeutic communication. Our findings also highlight the usefulness of focusing on moment-to-moment interactions in cross-cultural clinical practice.

Early Cultural Dialogues in Cross-Cultural Clinical Practice

This article examines the quality of cultural dialogues between clients and therapists when they initiate and integrate verbal references to culture in the beginning process of therapy. Six cross-cultural dyads in short-term–oriented community mental health services participated in the study. The initial three sessions of actual clinical encounters were taped, and conversation analysis was used for an intensive analysis of the treatment sessions. Despite the presence of a wide range of affectively charged cultural content raised by the clients, the therapists showed only minimal responses to these topics. The potential of therapeutically germane cultural dialogue was lost, and the discussion of material involving cultural differences regressed to monologues expressed by clients. In this sample, there was little talk that focused on cultural differences or similarities between clients and therapists. Implications and limitations of the study in cross-cultural clinical practice are discussed.

Translating Procedural Spine Science into Cross-Cultural Clinical Practice: Methodological Questions and Answers

In their reviews of the study of cervical radiofrequency neurotomy (RFN) by MacVicar, Borowczyk et al. [1], some of the referees raised questions that were not critical of the internal validity of the study but which pertained to its external validity. In essence, these questions concerned the context of the study and differences between New Zealand and the United States with respect to patients and medical practices. Conventionally, such questions would be answered in a covering letter to the satisfaction of the Editor. However, in the present case, the questions and answers contained information that would be of wider interest beyond the peer-review process. That information serves not only to elaborate and explain the study of MacVicar, Borowczyk et al. [1], but also to underscore the wider relevance of stringent standards of practice. For that reason, we have composed this letter to serve as a compendium to the published article. It provides answers to several of the key questions raised in the review process. At the time that the study was commenced, New Zealand was in a unique position. RFN was not practiced, was not available to patients, and was not reimbursed. In one sense, New Zealand was behind the rest of the world, but in another sense it had not been polluted with disparate methods of RFN of unknown efficacy. When a small group of practitioners wanted to make RFN available, the opportunity arose to do it well, and avoid mistakes made elsewhere in the world. The senior medical advisor of the single insurance company that covers accident compensation in New Zealand faced a dilemma. There was no universally accepted technique for cervical RFN, and no consistent protocol. Various Dutch, German, and other protocols had been found wanting [2], and their outcomes were not impressive. Consequently, …

A Working Model of Cross-Cultural Clinical Practice (CCCP)

A long-standing gap between clinical and cultural practice can lead clinicians to feel overwhelmed by the task of integrating clinical practice with a culturally sensitive approach, while working toward changes in clients’ lives. This article attempts to assist clinicians in their efforts to achieve this task. Using a Task-Analysis approach in the alliance research (Safran et al. 1994), this article discusses the development of Cross-Cultural Clinical Practice and proposes a detailed working model for its possible application. A case example is presented to highlight key components of the model. Limitations and implications of the model in clinical social work practice are also described.

Engagement in Cross-Cultural Clinical Practice: Narrative Analysis of First Sessions

Based on a larger process-outcome study on cross-cultural clinical practice, this report focuses on the client-practitioner engagement process during the first session in cross-cultural therapy. Nine cases with complete pre- and post-treatment measures, process measures, and verbatim session transcripts were selected. The cases represent a wide variety of client-practitioner ethno-cultural differences. The outcome of these cases was determined by a combination of objective and subjective measures. Client-practitioner interaction processes were subject to complex coding and process analysis, following a narrative research strategy, to discover patterns associated with positive cross-cultural engagement. Results showed that positive engagement is associated with effectively communicated cognitive understanding of the client’s needs and concerns, emotional attunement, and appropriate handling of specific cultural experiences.

Preparation for social work students to do cross-cultural clinical practice

English Thorough preparations are required to do placements in an unfamiliar culture. Applying the concepts of proficiency and cross-cultural understanding, the article explores the development of a suitable student role, safety measures, the language barrier and how to keep writing and learning in a challenging placement situation. French Des préparations minutieuses sont requises pour effectuer un placement en stage dans une culture non familière. Appliquant les concepts de compétence et de compréhension interculturelle, l’article explore le développement d’un rôle d’étudiant approprié, des mesures de sécurité, de la barrière linguistique et la façon de continuer à écrire et apprendre dans une situation de placement stimulante. Spanish Es necesario prepararse a fondo para realizar una práctica dentro de una cultura ajena. Aplicando los conceptos de competencia y entendimiento inter cultural, el artículo explora el desarrollo de un rol estudiantil apropiado, medidas de seguridad, la barrera del lenguaje y cómo mantenerse escribiendo y aprendiendo en una práctica desafiante.

A cultural accommodation model for cross-cultural psychotherapy: Illustrated with the case of Asian Americans.

As an extension of F. T. L. Leong's (1996) integrative model, this article presents the cultural accommodation model (CAM), an enhanced theoretical guide to effective cross-cultural clinical practice and research. Whereas F. T. L. Leong's model identifies the importance of integrating the universal, group, and individual dimensions, the CAM takes the next step by providing a theoretical guide to effective psychotherapy with culturally different clients by means of a cultural accommodation process. This model argues for the importance of selecting and applying culture-specific constructs when working with culturally diverse groups. The first step of the CAM is to identify cultural disparities that are often ignored and then accommodate them by using current culturally specific concepts. In this article, several different cultural "gaps" or culture-specific constructs of relevance to Asian Americans with strong scientific foundations are selected and discussed as they pertain to providing effective psychotherapy to this ethnic minority group. Finally, a case study is incorporated to illustrate application of the CAM. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Exploring Dimensions of Culturally Sensitive Clinical Styles with Latinos

This study sought to identify dimensions of culturally sensitive clinical practice by comparing the personal clinical styles of Latino and non-Latino clinicians, and their clinical decisions in respect to Latino immigrant clients. A combination of qualitative and quantitative methods were used. Sixty Latino American clinicians and 47 non-Latino (White) clinicians in Northern California completed the Achieving Styles Inventory (ASI) which yields information on direct, instrumental and relational styles. Demographic data were obtained as well as information on language proficiency and years of clinical experience. Statistical analysis included uses of t-test, ANOVA, and multiple regression analysis and revealed significant differences between the two groups in personal achieving styles within all three domains. There were no significant differences on the demographic variables. Nine clinician members of each ethnic group were interviewed in-depth through non-directive interviewing styles to assess their clinical decision making via use of a case vignette. Content analysis pointed to similarities and differences in proposed assessment and intervention strategies. The Latino group displayed more culturally relevant interpretations. The non-Latino clinicians were more directive and instrumental than the Latinos who put more emphasis on self disclosure, case management, use of Spanish with the client, and crisis intervention. This finding is consistent with both the quantitative data analysis of ASI hypotheses and the expected linguistic/cultural findings of the qualitative content analysis. Bilingual non-Latino White clinicians showed more cultural sensitivity and competence than the monolingual non-Latino clinicians. These findings suggest that linguistic/cultural match and linguistic/cultural compatibility are important in cross-cultural clinical practice.