The formative method for adapting psychotherapy (FMAP): A community-based developmental approach to culturally adapting therapy.

How is psychotherapy culturally adapted for ethnic minorities? Although there has been growing interest in doing so, few therapy adaptation frameworks have been developed. The majority of these frameworks take a top-down theoretical approach to adapting psychotherapy. This article introduces a community-based developmental approach to modifying psychotherapy for ethnic minorities. The formative method for adapting psychotherapy (FMAP) is a bottom-up approach that involves collaborating with consumers to generate and support ideas for therapy adaptation. It involves 5 phases that target developing, testing, and reformulating therapy modifications. These phases include (a) generating knowledge and collaborating with stakeholders, (b) integrating generated information with theory and empirical and clinical knowledge, (c) reviewing the initial culturally adapted clinical intervention with stakeholders and revising the culturally adapted intervention, (d) testing the culturally adapted intervention, and (e) finalizing the culturally adapted intervention. Application of the FMAP is illustrated using examples from a study adapting psychotherapy for Chinese Americans, but it can also be readily applied to modifying therapy for other ethnic groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy research with ethnic minorities: Empirical, ethical, and conceptual issues.

There is an increasing demand for psychotherapy among ethnic minority populations. Yet, there is not adequate evidence that empirically supported therapies (ESTs) are effective with ethnic minorities. Ethical guidelines suggest that psychotherapies be modified to become culturally appropriate for ethnic minority persons. Conceptual approaches have identified interdependence, spirituality, and discrimination as considerations for culturally sensitive therapy (CST). However, there is no more empirical support for the efficacy of CSTs than there is for the efficacy of ESTs with ethnic minority populations. The chasm between EST and CST research is a function of differences between methods and researchers in these 2 traditions. Specific recommendations for research collaboration between CST and EST researchers are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural control in psychotherapy with minority clients.

Reviews the literature on mental health services for minority clients, suggesting that these persons experience special problems with the traditional mental health delivery system. Epidemiological and attitude studies have indicated that minority client and majority therapist expectations for psychotherapy are often discrepant. Counseling and psychotherapy outcome research on therapist–client racial pairing has yielded inconclusive results at present. It is hypothesized that the therapist–client racial pairing may interact with level of therapist dominance in affecting psychotherapy outcome. Dominant majority clinicians may manipulate minority persons toward majority values, which may comprise a form of cultural control. Highly dominant clinicians are posited to function more effectively with culturally similar clients than with culturally different clients in that domination may be appropriate to a certain degree in culturally homogeneous settings. Low dominant clinicians are posited as being more effective than highly dominant clinicians with culturally different clients in that they would be more likely to attempt to understand the client's cultural perspective in a nonmanipulative manner. (100 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Cultural difference and the therapeutic alliance: An evidence-based analysis.

The research on positive psychotherapy outcome consistently indicates that the quality of the alliance is important across different models of psychotherapy (D. E. Orlinsky, M. H. Ronnestad, & U. Willutzki, 2004; B. E. Wampold, 2000). Social psychological research has documented how "unintentional bias" can produce barriers to university admissions, employment, and advancement of well-qualified members of ethnic minority groups (J. F. Dovidio, S. L. Gaertner, K. Kawakami, & G. Hodson, 2002). Neuroscience is further confirming social psychological responses associated with race (J. L. Eberhard, 2005). Unintentional bias identified in social psychological research may be part of the psychotherapist/client interaction, interfere with the therapeutic alliance, and partly account for the high dropout rates and underutilization of psychotherapeutic services by people of color. The purpose of this article is to provide an evidence-based analysis of how psychologists in practice may unintentionally interfere with development of quality alliances with culturally different clients or patients and thus contribute to the barriers to effective multicultural counseling and psychotherapy. Principles from the American Psychological Association's (2003) multicultural guidelines and a review of relevant research are applied in suggesting strategies to reduce bias and to develop culturally appropriate skills in psychological practices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Culturally adapted mental health intervention: A meta-analytic review.

There is a pressing need to enhance the availability and quality of mental health services provided to persons from historically disadvantaged racial and ethnic groups. Many previous authors have advocated that traditional mental health treatments be modified to better match clients' cultural contexts. Numerous studies evaluating culturally adapted interventions have appeared, and the present study used meta-analytic methodology to summarize these data. Across 76 studies the resulting random effects weighted average effect size was d = .45, indicating a moderately strong benefit of culturally adapted interventions. Interventions targeted to a specific cultural group were four times more effective than interventions provided to groups consisting of clients from a variety of cultural backgrounds. Interventions conducted in clients' native language (if other than English) were twice as effective as interventions conducted in English. Recommendations are provided for improving the study of outcomes associated with mental health interventions adapted to the cultural context of the client. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial/ethnic disparities in therapist effectiveness: A conceptualization and initial study of cultural competence.

As a result of mental health disparities between White and racial/ethnic minority clients, researchers have argued that some therapists may be generally competent to provide effective services but lack cultural competence. This distinction assumes that client racial/ethnic background is a source of variability in therapist effectiveness. However, there have been no direct tests of the therapist as a source of health disparities. We provided an initial test of the distinction between general and cultural competence by examining client racial/ethnic background as a source of variability in therapist effectiveness. We analyzed cannabis use outcomes from a psychotherapy trial (N = 582) for adolescent cannabis abuse and dependence using Bayesian multilevel models for count outcomes. We first tested whether therapists differed in their effectiveness and then tested whether disparities in treatment outcomes varied across therapist caseloads. Results suggested that therapists differed in their effectiveness in general and that effectiveness varied according to client racial/ethnic background. Therapist effectiveness may depend partially on client racial/ethnic minority background, providing evidence that it is valid to distinguish between general and cultural competence. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cultural competence and psychotherapy: Applying anthropologically informed conceptions of culture.

The authors apply two contemporary notions of culture to advance the conceptual basis of cultural competence in psychotherapy: Kleinman's (1995) definition of culture as what is at stake in local, social worlds, and Mattingly and Lawlor's (2001) concept of shared narratives between practitioners and patients. The authors examine these cultural constructs within a clinical case of an immigrant family caring for a young boy with an autism-spectrum disorder. Their analysis suggests that the socially based model of culture and the concept of shared narratives have the potential to broaden and enrich the definition of cultural competence beyond its current emphasis on the presumed cultural differences of specific racial and ethnic minority groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racism: Calling a Spade a Spade.

Research has documented the deleterious effects of racism on the mental health of people of color. However, the practice of psychotherapy sorely underutilizes these important findings, thereby providing less-than-optimum care. Through the presentation of research and personal stories, the author discusses the necessity of naming racism and of identifying its effects. Guidelines are suggested for transforming difficult racial dialogues into healing experiences for clients, and the necessity of taking stands against racism inside and outside of the therapy office is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirical search for psychotherapists' gender competence in psychotherapy.

Over the past half century, psychotherapy research has demonstrated that psychotherapy outcomes do not vary based on clients’ gender (Clarkin & Levy, 2004; Garfield, 1994; Wierzbicki & Pekarik, 1993). However, most studies assumed that all psychotherapists are equally competent to treat men and women, thus potentially missing essential information about variations in psychotherapy outcomes. In fact, there is a paucity of studies that have examined if psychotherapists’ gender competence truly exists. We propose that psychotherapists’ gender competence should be defined as the psychotherapist’s ability to achieve positive psychotherapy outcomes with either female or male clients. This study examined the relationship between clients’ gender and psychotherapy outcomes and if psychotherapists varied in their abilities to produce positive psychotherapy outcomes for female and male clients. The sample included 93 male and 229 female clients treated by 31 psychotherapists. Consistent with previous research, the results demonstrated that clients’ gender was not related to psychotherapy outcomes. However, compared to other psychotherapists, some psychotherapists were better at treating men, whereas others were better at treating women. The results of this study demonstrate that psychotherapists’ gender competence exists and relates directly to the psychotherapy outcomes (i.e., psychological well-being) of clients. Implications for psychotherapy practice, training, and research are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contextualizing discourse on a philosophy of science for psychotherapy integration.

The present article introduces the second installment of this special section (Anchin, 2005) and focuses on the conjunction between philosophy of science and psychotherapy integration. The author suggests that the current state of research in the integrative field offers a timely opportunity for discussion and debate about a philosophy of science appropriately suited to the distinctive nature of psychotherapy integration. To contextualize such discourse, the principal domains of interest in philosophy of science are described, followed by discussion of the two opposing philosophical positions, naturalism and antinaturalism, that have long dominated debates about scientific knowledge in the social sciences. The divergent modes of inquiry spawned by these two positions are then examined, followed by discussion of the degree of impact each mode of inquiry has had on guiding psychotherapy research. The author puts forward core dimensions of a scientific paradigm for psychotherapy integration logically and operationally consistent with the epistemological pluralism of integrative theory and practice; noted, as well, are benefits for psychotherapy integration, and for psychotherapy research and the discipline of psychology more broadly. Against this backdrop, central themes of Robert Elliott's (2008) ensuing analysis and Robert Woolfolk's and Frank Richardson's (2008) commentary are highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Clinical guidelines in cross-cultural mental health.

Reviews the book, Clinical guidelines in cross-cultural mental health edited by Lillian Comas-Diaz and Ezra E. H. Griffith (see record 1988-97772-000). This volume represents the latest work on psychotherapy with ethnic/racial minority populations, and was intended for mental health practitioners as well as academicians. The book is divided into three parts. The first section has six chapters addressing the role of "ethnosociocultural" factors such as ethnicity, family values, language, religion, politics, and race in the cross-cultural delivery of psychotherapeutic care. The second section focuses on clinical practice with specific ethnic/racial groups including Afro-Americans, Mexican-Americans, Puerto Ricans, Cubans, Southeast Asian refugees, and West Indians. A final section of one chapter by Comas-Diaz discusses the "state of the art" in cross-cultural mental health. Three factors set this book apart from previous ones on this topic: 1) devotion of an entire section to core ethnosociocultural factors; 2) use of case vignettes to illustrate important cross-cultural issues in mental health; and 3) provision of specific recommendations for the practitioner. Unfortunately, the effort falls short due to the strong academic approach to clinical issues evident throughout the book. Moreover, there was substantial variability in contributors' use of case material and provision of specific recommendations. This uneven coverage, one of the prime drawbacks of many edited volumes, may limit its appeal to practitioners. This book is an improvement over previous texts in this area, but it is by no means a clinician's guide to cross-cultural mental health because of the pervasive academic influence throughout. Consequently, there is an imbalance in favor of didactic over pragmatic approaches to cross-cultural mental health. Thus this book seems more suitable for clinicians in training than for clinicians in practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Future directions in studies of trauma among ethnoracial and sexual minority samples: Commentary.

Objective: Studies examining psychological trauma or posttraumatic stress disorder (PTSD) in ethnoracial or sexual minority groups are relatively few. The Journal of Consulting and Clinical Psychology recently published 4 articles (Balsam, Lehavot, Beadnall, & Circo, 2010; Harrington, Crowther, & Shipherd, 2010; Lester, Resick, Young-Xu, & Artz, 2010; Marshall, Schell, & Miles, 2009) that examine trauma exposure and posttraumatic outcomes in ethnoracial and sexual minority samples. This commentary focuses on the overlap between traumatic stress and diversity studies in order to consider future areas in need of development. Method: Within the framework of a generalized overview of current trends in the study of traumatic stress, an assessment of the strengths and limitations of these 4 articles is provided. Populations and syndromes covered by the articles include ethnoracial differences in child maltreatment and adverse mental health outcomes among sexual minority participants, PTSD symptom elevations among Hispanic Americans, binge eating and the strong Black woman schema, and retention of African American female participants in cognitive behavioral psychotherapy trials for PTSD. Results: Recommendations to enhance culturally competent traumatic stress studies include increasing the examination of within-group cultural variability and key social, contextual, and cultural variables and constructs; examining the temporal sequencing of traumatic events and key transitions in sexual and ethnic minority identity development; and conducting prevention and treatment studies for those sexual minority children most at risk for maltreatment. Conclusions: By following these recommendations, the next generation of studies of traumatic stress studies will be enhanced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

No more than skin deep.

Comments on the article by J. E. Helms (see record 1993-07951-001) in which it was claimed that racial differences in IQ performance are culturally biased. It is argued that Helms gives the impression that Blacks are culturally, cognitively, and socially different from Whites. However, evidence shows that IQ tests appear to measure the same psychological attributes in American Whites and Blacks. Further, Helms presented misleading genetic information, and she failed to appreciate the degree of racial similarity of genetic composition. It is suggested that ethnic and racial differences may be "no more than skin deep" because physical dissimilarities lead to false attributions of psychological difference, when in reality people of different ethnic and racial backgrounds are broadly psychologically alike. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Latino healing: The integration of ethnic psychology into psychotherapy.

This article argues for the need to culzturally adapt mainstream psychotherapy to Latino populations. It discusses ethnic psychology as a cultural resilient practice. Examples of Latino ethnic psychology include cuento, dichos, and spirituality. The article introduces Latino healing as the integration of ethnic psychology into mainstream psychotherapy. A clinical vignette illustrates the application of Latino healing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ten considerations in addressing cultural differences in psychotherapy.

As the United States population grows more culturally diverse, it is increasingly likely that psychologists will treat patients from dissimilar cultural backgrounds. Psychologists are often undecided about whether it is therapeutically appropriate to address cultural differences. Ten clinical considerations regarding the appropriateness of discussing cultural differences with patients are described. Examples are provided of how these suggested guidelines may apply to clinical practice. The literature that has supported addressing differences, including selected theoretical models, is cited in the context of these recommendations. All psychotherapy cases are distinct; therefore, these general guidelines should be adapted to the requirements of the individual patient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Generating Ethnic Minority Student Success (GEMS): A qualitative analysis of high-performing institutions.

Less than one-half of all underrepresented racial and ethnic minority students who begin college at a 4-year institution with aspirations to earn a bachelor's degree achieve that goal within 6 years. The aim of this study was to identify and analyze the institutional factors that contribute to racial and ethnic minority student success at three predominantly White institutions with high and equitable underrepresented racial and ethnic minority student retention and graduation rates. Sixty-five individual interviews were conducted, and documents were collected across these three high-performing colleges. From the analysis of those interviews and documents emerged four common and salient elements of the institutional cultures that promote success among students of color at the three campuses. Implications for research and practice are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)