Culturally diverse groups and MMPI interpretation.

In this article I suggest that culturally determined thought processes, including ethnocentrism, world view, and etic preoccupation predispose interpretation of the Minnesota Multiphasic Personality Inventory (MMPI) to unintentional bias as a result of minimization of consistent group differences in item responding. Group personality as evidenced by group consciousness has been described by identity measures for Afro-Americans and acculturation indices for Asian Americans, Hispanic Americans, and Native Americans. Instruments for world view measurement have been developed from several perspectives. Research on the potential cultural content of differences in MMPI item responding by Afro-Americans and other cultural groups continues to be necessary, although a more systematic approach to interpretation that includes identity and world view measures is now feasible. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Culturally sensitive assertiveness training for ethnic minority clients.

This article serves as a comprehensive resource to help bridge the gap of cultural understanding for those using assertiveness training with ethnic minority clients. Therapists providing cross-cultural assertiveness training must be certain that gaining such skills is a value shared by the client and not imposed by the therapist. A more culturally appropriate approach includes the following general assessment strategies: determining the etiology of the lack of assertiveness; using self-report inventories that avoid words, slang, or situations that may not be meaningful to the client; and the developing norms for the cultural group for which the inventory will be used. General treatment strategies may include "message matching," backup assertion, and discriminative cue learning. Specific strategies that are relevant for each cultural group are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An examination of the efficacy of conjoint behavioral consultation with diverse clients.

This study explored the efficacy of conjoint behavioral consultation (CBC) by assessing objective outcomes and social validity with a sample of students with and without diversity. Diversity characteristics that were investigated included ethnicity, socioeconomic status, family composition, maternal education level, and language spoken in the home. Behavioral change, goal attainment, acceptability, satisfaction, and perceptions of efficacy of the CBC model were measured with 125 students representing varying levels of diversity, and 192 target behaviors. Data were collected across 8 years of a federally funded training program across two states. Findings indicated that CBC-mediated interventions yielded generally high effect sizes regardless of the presence of diversity or the number of diverse characteristics exhibited. Social validity measures also yielded very favorable results, suggesting that participants (teachers and family members, including those who experienced some form of diversity) found the procedures positive. Implications for research and practice are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical assessment research with older adults.

Methodological issues in geropsychological assessment research are discussed and exemplified with recent investigations. Increased use of short-term longitudinal designs, more diverse and representative sampling, and routine inclusion of measures of health are among the recommendations made for future studies. Caution is urged in the application of new tests or screening batteries until sufficient independent validation studies are completed. Research contrasting neuropsychological performance of older persons from different racial and ethnic groups is briefly reviewed, and applications of geropsychological assessment to practical arenas such as competency determination are critiqued. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Heterogeneity of cognitive trajectories in diverse older persons.

This study examined trajectories of cognitive change in psychometrically matched measures of episodic memory, semantic memory, and executive function in an ethnically, demographically, and cognitively diverse sample of older persons. Individual rates of change showed considerable heterogeneity in each domain. Baseline clinical diagnosis predicted differential change in semantic memory and executive function, dementia > mild cognitive impairment (MCI) > normal, but average decline in verbal episodic memory was similar across all 3 diagnostic groups. There was substantial overlap of distributions of cognitive change across baseline diagnostic groups for all 3 measures. Cognitive change was strongly related to change in clinical diagnosis. Rapid and similar change was present for all 3 cognitive measures in patients with dementia and in those with normal cognition and those with MCI who progressed clinically. In cognitively normal patients, verbal episodic memory change was greater than change in the other two domains. Global status, measured by the Clinical Dementia Rating scale (Morris, 1993), predicted change in semantic memory and executive function, whereas APOE genotype predicted change in verbal episodic memory, and age had no effect on rates of change in any domain independent of global status and APOE. Results show important limitations in using cross-sectional diagnosis to predict prognosis and suggest that research to identify robust predictors of cognitive change across the full spectrum from normal to dementia is needed for better early identification of diseases that cause progressive decline. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health providers' perceptions of cultural variables in evaluating ethnically diverse clients.

The study assessed anonymously the perceptions of 107 mental health providers concerning the importance of considering cultural variables in the assessment of mental disorders in ethnic minority individuals. Although the providers overwhelmingly reported a belief in the importance of cultural variables, a relatively small percentage considered themselves highly successful in assessing the degree of the clients' assimilation and acculturation. Additionally, 73% of the respondents reported a high degree of need for more culturally focused training. The results indicate the need to increase such training in order to better serve minority individuals and the possible need to increase the numbers of mental health providers serving minority clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measurement invariance of neuropsychological tests in diverse older persons.

Objective: Comparability of meaning of neuropsychological test results across ethnic, linguistic, and cultural groups is important for clinicians challenged with assessing increasing numbers of older ethnic minorities. We examined the dimensional structure of a neuropsychological test battery in linguistically and demographically diverse older adults. Method: The Spanish and English Neuropsychological Assessment Scales (SENAS), developed to provide psychometrically sound measures of cognition for multiethnic and multilingual applications, was administered to a community dwelling sample of 760 Whites, 443 African Americans, 451 English-speaking Hispanics, and 882 Spanish-speaking Hispanics. Cognitive function spanned a broad range from normal to mildly impaired to demented. Multiple group confirmatory factor analysis was used to examine equivalence of the dimensional structure for the SENAS across the groups defined by language and ethnicity. Results: Covariance among 16 SENAS tests was best explained by five cognitive dimensions corresponding to episodic memory, semantic memory/language, spatial ability, attention/working memory, and verbal fluency. Multiple Group confirmatory factor analysis supported a common dimensional structure in the diverse groups. Measures of episodic memory showed the most compelling evidence of measurement equivalence across groups. Measurement equivalence was observed for most but not all measures of semantic memory/language and spatial ability. Measures of attention/working memory defined a common dimension in the different groups, but results suggest that scores are not strictly comparable across groups. Conclusions: These results support the applicability of the SENAS for use with multiethnic and bilingual older adults, and more broadly, provide evidence of similar dimensions of cognition in the groups represented in the study. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychological assessment of older adults.

Older adults experience a diverse range of cognitive, emotional, and social problems for which psychological assessment may be beneficial. This article describes sequential steps in geropsychological assessment and reviews some of the procedures that can be used for making a differential diagnosis, establishing a baseline for longitudinal follow-up, or planning for interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working with Mexican-American clients.

Addresses issues crucial in serving mental health needs of Mexican-American clients. Topics include demographics, language, acculturation, social support, etiquette, and other information useful in developing initial hypotheses and treatment goals. The various topics and possible interventions are discussed within the framework of 3 case vignettes. The author's goal is to increase the reader's sensitivity to cultural differences, help clinicians avoid potential stumbling blocks, and make existing programs more accessible by overcoming barriers which discourage or exclude potential Mexican-American clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

American psychotherapists of diverse persuasions: Characteristics, theories, practices, and clients.

319 practicing psychotherapists from 3 professional associations, Divisions 29 (Psychotherapy) and 32 (Humanistic) of the American Psychological Association and the Association for Advancement of Behavior Therapy, were surveyed concerning their personal characteristics, training experiences, and predominant professional activities. The survey also assessed their preferred and least preferred theoretical orientation, structure (frequency and duration) of therapy, diagnoses of usual therapy case load, and perceived effectiveness with various types of patients. Ss' theoretical orientations were largely consistent with group membership. Differences among the groups in terms of their characteristics, activities, types of clients, and treatment structure appeared to be consistent with the dominant theoretical orientation of the group. Preferred types of clients were generally related to base-rate outcome expectancies of psychosocial interventions (i.e., severity and duration of the disorder) but did not differ among the 3 groups. It is suggested that no single professional association is representative of American psychologists engaged in psychotherapy; thus, many associations and disciplines need to be sampled to assess accurately the field of psychotherapy and its practitioners. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rational restructuring versus desensitization with clients of diverse conceptual levels: A test of a client-treatment matching model.

Examined the efficacy of matching treatment orientations differing in structure with clients differing in conceptual level (CL). Theoretically, "matched" conditions (i.e., high-structure treatment with low-CL clients and low structure treatment with high-CL clients) should be more effective than "mismatched" conditions (i.e., high-structure treatment with high-CL clients and low structure treatments with low-CL clients). 59 socially anxious males (as determined by the Social Anxiety Scale) were assessed as either high or low on CL (Paragraph Completion Test) and randomly assigned to rational cognitive restructuring (low structure), systematic desensitization (high structure), or a waiting list control group. After 5 1-hr-per-wk treatment sessions, analyses of the Social Avoidance and Distress Scale, Fear of Negative Evaluation Questionnaire, Behavioral Checklist for Interpersonal Anxiety, and a cognitive response assessment failed to confirm the matching model. Superiority of treatment effects relative to controls was obtained, with rational restructuring emerging as a preferred treatment. Discussion focuses on a comparison of this study with one in which the matching effect was obtained. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Assessing and treating culturally diverse clients: A practical guide.

Reviews the book, Assessing and treating culturally diverse clients: A practical guide by Freddy A. Panaigua (see record 1996-97152-000). This book is a timely and provocative delineation of highly relevant considerations to be made by counselors, psychotherapists, and other mental health professionals in the delivery of services to multicultural groups. The book deals with four ethnic populations in the United States—African American, Hispanic, Asian, and American Indian. Panaigua's contribution is part of a series on Multicultural Aspects of Counseling by Sage Publications. The purpose of the series is to increase the mental health practitioner's knowledge and sensitivity to cultural differences and to assist in alleviating bias in the therapeutic process. This purpose is accomplished with precision and insight by Panaigua. Unlike some other books dealing with cultural diversity, Panaigua's work offers specific treatment methods which have been demonstrated to be successful in treating members of the targeted groups. Problem solving and social skills training are recommended in some cases. In other instances, assertiveness training, music therapy, or direct advice are the modalities of choice. In other cases, education, medication, or behavioral approaches are preferred. Assessing and Treating Culturally Diverse Clients can serve the educational needs of graduate students in the fields of psychology, counseling, family therapy, and social work. It is an excellent guide for use in either the training or practice of these helping professions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of group psychotherapy for older adult clients: A meta-analysis.

This review examined the effectiveness of group psychotherapy for older (55+) adults. Results from 44 studies with pre-post designs and 27 controlled studies indicated that group psychotherapy benefits older adults, with average rs of .42 and .24 for pre-post and controlled designs, respectively. The type of therapy provided and the age of the clients were associated with pretreatment to posttreatment improvement. Clients in cognitive-behavioral group therapy improved more than those receiving reminiscence therapy. The older the average age of the group members, the less they benefited from therapy. Number of sessions attended, length of therapy sessions, the percentage of women in the group, and client living situation were not significant moderators of outcome. Overall, group interventions for older adults appear to be effective and the average effect size for pre-post studies was quite similar to those yielded by meta-analyses of group therapy with younger adults and adolescents. However, the average effect size for controlled studies of group therapy with older adults appears to be somewhat smaller than the values reported in meta-analyses with younger clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy with bicultural Hispanic clients.

Presents examples of how therapists can deal with difficulties encountered by bicultural Hispanics as they cope with acculturation issues. The integration of understanding and assessing acculturation within a multidimensional perspective and the modification of traditional therapeutic models is discussed. Specific techniques based on theoretical models, such as cognitive-behavior therapy, are described. Bicultural therapy interventions working with language, feelings, repressed emotions, cultural loss, and dual-cultural environments are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maintenance of quality of life improvements in diverse rural older adults.

The maintenance of effects from home-delivered cognitive-behavioral therapy (CBT) was examined. One hundred thirty-four participants, predominantly African American and primarily rural, low-resource, and physically frail, were randomly assigned to either immediate or delayed CBT. The six-month follow-up assessments indicated that among those who remained in the study, participants evidenced significantly improved quality of life and reductions in psychological symptoms at follow-up, relative to pretreatment levels. Posttreatment gains were maintained at follow-up. These data suggest that treatment effects can be achieved and perhaps maintained with a disadvantaged sample of older adults and suggest that evidence-based treatments delivered through nontraditional means can have effects beyond posttreatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Ecological and psychocultural mediators in the delivery of services for urban, culturally diverse Hispanic clients.

Influences on underuse of mental health services by the urban, low-income Latino subgroup are analyzed through a systems-cultural framework. Results of a review of over 100 applied, empirical, and theoretical published works in the last 14–26 yrs strongly suggest that when social-ecological and psychocultural perspectives are used by service providers, their therapeutic relationship, techniques, and treatment plan become more clinically and culturally compatible with the presenting problems of the urban Latino client. Accuracy of assessment and effectiveness of treatment also have been found to increase. Recommendations for the overlapping domains of clinical practice, graduate training, and program and policy development are offered. By augmenting assessment and intervention models to encompass a psychocultural and socioecological view, professionals move toward a greater concordance with the life problems, phenomenology, and value orientation of urban, culturally diverse Hispanic families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training psychologists to work with minority clients: A prototypic model with Black clients.

Presents evidence that indicates the failure of current training programs to train clinicians to meet the psychotherapeutic needs of minority clients. Major problems with current training models are their deficiency in providing professionals with sufficient skills to retain minority clients in therapy and their violation of psychologists' ethical standards as established by the American Psychological Association. A course designed to explore issues relevant to the understanding and assessment of minority clients' psychological problems and to provide insights into effective therapeutic intervention for these problems is described. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy with Southeast Asian American clients.

The number of Asian Americans has increased significantly in the United States because of political and geographical dislocations. Great emotional stress results from these dislocations, and there is an urgent and growing need for mental health services capable of serving this minority group. Nevertheless, existing American professional training is ill equipped to provide the skills and knowledge necessary to meet adequately the needs of our Asian-American neighbors. This article analyzes the problem and presents a number of case studies with recommendations for effective psychotherapeutic work with these clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Issues in psychotherapy with EAP clients.

Suggests that employee assistance programs (EAPs) are growing at a rapid rate, partly in response to the success of psychotherapy. This emerging service delivery pattern remains unregulated, and the consumer is potentially easily abused. Several cases highlight the unique blend of business, clinical, ethical, legal, and moral concerns arising in the relationship between the provider, EAP counselor, and consumer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working with adult clients who may have experienced childhood abuse: Recommendations for assessment and practice.

The delayed memory debate has generated many questions about therapeutic practices that are likely to be beneficial and detrimental to clients. This article proposes components of optimal practice for working with adult clients who may have been abused as children. The recommendations are organized around the following themes: (a) competence, (b) assessment and treatment planning, (c) psychotherapy process and technique, (d) memory issues, (e) and ethics. The authors emphasize the importance of a collaborative therapeutic relationship and urge clinicians to proceed cautiously when encountering treatment issues for which scientific knowledge and consensus are still evolving. (PsycINFO Database Record (c) 2010 APA, all rights reserved)