African Americans' Perceptions of Psychotherapy and Psychotherapists.

Do you have a multicultural practice? Do you understand the attitudes and expectations African Americans hold about mental health services? The attitudes and beliefs of 201 African Americans regarding psychotherapists, psychotherapy, and barriers to treatment were explored by means of focus groups. Key banners to service utilization included stigma, lack of knowledge, lack of affordability, lack of trust, impersonal service, and lack of cultural understanding. Participants reported that race should not matter in therapy, but they often believed that psychologists were insensitive to the African American experience. The implications of participants' reports for meeting African American mental health and therapy needs are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural mistrust and mental health help-seeking attitudes among Filipino Americans.

As low as the rate of mental health help-seeking is among Asian Americans, Filipino Americans seek mental health services at a much lower rate even compared with other Asian Americans. Despite the field’s progress in identifying and understanding factors that may influence mental health help-seeking attitudes among Asian Americans, despite research on other minority groups suggesting that cultural mistrust may influence attitudes toward seeking professional psychological help, and despite the abundance of literature documenting the historical and contemporary experiences of oppression by Filipino Americans, the possibility that cultural mistrust may play a significant role in Filipino Americans’ mental health help-seeking attitudes have yet to be empirically investigated. Thus, using a sample of 118 Filipino Americans, the current study demonstrates that higher levels of cultural mistrust is related to lower likelihood of seeking professional psychological help. Furthermore, cultural mistrust predicted variance in mental health help-seeking attitudes that are not accounted for by income, generational status, loss of face, and adherence to Asian cultural values. Implications for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical practices with African Americans: Juxtaposition of standard clinical practices and Africentricism.

Rapidly changing demographics necessitate increased awareness of the impact of race, ethnicity, and levels of acculturation on treatment efficacy and differential diagnosis of ethnic minorities. Increasingly, psychologists are in a position of providing treatment for clients whose cultural background differs from their own. Because African Americans have historically underutilized mental health services, sensitivity to the cultural variables represented by this group is a growing concern. An integrated approach to conceptualizing, evaluating, and diagnosing African Americans from a culturally sensitive, Africentric perspective is provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Congruence between culturally competent treatment and cultural needs of older Latinos.

This study investigated a new 2-factor construct, termed cultural congruence, which is related to cultural competence in the delivery of mental health services to ethnic minority clients. Cultural congruence was defined as the distance between the cultural competence characteristics of the health care organization and the clients’ perception of those elements according to their cultural needs. The measure evidenced both reliability and validity in predicting criterion-related indicators. Older Hispanic/Latino clients (N = 272) receiving mental health services either through integrated primary care or referral to specialized mental health care were assessed for depression and anxiety symptomatology and health status at baseline, 3-, and 6-month follow-up treatment. Results indicated that cultural congruence predicted treatment outcomes (reduction of symptomatology) independent of treatment and evidenced moderator effects with respect to depression, suicidality, anxiety, and physical health criteria. Cultural congruence was more effective under the condition of the enhanced specialty referral model than under the integrated primary care model. Results are discussed in terms of how the new construct of cultural congruence extends knowledge of culturally competent mental health practice among the older Hispanic/Latino population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Colonial Mentality Scale (CMS) for Filipino Americans: Scale construction and psychological implications.

Colonial mentality, or internalized colonialism, has been discussed by scholars and by Filipino American community members as a significant factor in the experiences of contemporary Filipino Americans, yet this construct has not received empirical attention in psychology. The authors of the current study addressed this gap in the Asian American psychological literature by developing the Colonial Mentality Scale for Filipino Americans, a theoretically derived and psychometrically tested multidimensional measure of colonial mentality. Exploratory (n = 292) and confirmatory (n = 311) factor analyses on Internet-obtained data suggest that colonial mentality among Filipino Americans is best conceptualized and measured as composed of 5 related factors, each of which represents unique manifestations of the construct. Results also suggest that colonial mentality is associated with the psychological well-being and mental health of modern day Filipino Americans. Research and clinical implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The mental health of Asian Americans.

Reviews the book, The mental health of Asian Americans by Stanley Sue and James K. Morishima (1982). In The Mental Health of Asian Americans, Sue and Morishima assess the current status of theory and research strategies in this field and initiate dialogue regarding future directions for our investigative energies and service delivery efforts. They are largely successful at this ambitious mission. Their work represents one of the best and most comprehensive texts on the special issues related to Asian-American mental health. Although this book was published in 1982, the theories presented and issues discussed remain extremely pertinent to the problems encountered today in providing services to this population. The authors' major intent is not to demonstrate how to deal with cross-cultural issues in treating Asian-American clients, although therapeutic techniques with a particular client may be extrapolated from their discussion and numerous case examples. Instead, the authors focus on strategies for improving research and delivery of mental health services, and attaining a theoretical understanding of treatment issues within the cultural context. The content is aimed at those who are in training or currently participating in mental health research and service delivery to persons of Asian descent. Yet, this book is of interest to all professionals who are seeking a well-researched text which is grounded in theory and describes the importance of cultural factors in developing mental health services to an ethnic minority population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural themes in the psychotic symptoms of African American psychiatric patients.

Professional psychologists need to recognize ethnic/racial differences between African Americans and European Americans in psychotic symptom expression to treat individuals with severe mental illness from various cultural backgrounds. Specifically, they need to understand confluent paranoia or the interaction between culture and pathology in psychotic symptom expression. To assist mental health professionals, the present study identified cultural themes in the delusions and hallucinations of a sample of 156 African American psychiatric patients via content analysis. Race-related themes and religious themes were observed in the psychotic symptoms of these patients assessed with the Structured Clinical Interview for DSM IV. Race-related and religious content were manifested in different types of delusions. Race-related themes were more common in persecutory delusions, whereas religious themes occurred more often in other delusions. Race-related themes were associated more with delusions, while religious themes correlated with both delusions and hallucinations. Implications for the treatment of confluent paranoia in African Americans are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Race differences in psychopathology and disparities in treatment seeking: Community and jail-based treatment-seeking patterns.

Whites in community samples use mental health services at a much higher rate than African Americans (Kessler et al., 2005). Is this also the case among those in jails? In this study of jail inmates (229 African American, 185 White), there were no race differences in the overall need for mental health treatment (63% of participants had significant symptoms on the Personality Assessment Inventory), but race differences in the level and types of symptoms were evident. In addition, although Whites were more likely to report preincarceration treatment, there were no differences in treatment seeking or access to mental health programs while in jail, implying that if barriers to treatment in the community were removed (cost/insurance, location/transportation, time), racial disparities in treatment utilization may be reduced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural and contextual influences in mental health help seeking: A focus on ethnic minority youth.

In this article, a mental health help-seeking model is offered as a framework for understanding cultural and contextual factors that affect ethnic minority adolescents' pathways into mental health services. The effects of culture and context are profound across the entire help-seeking pathway, from problem identification to choice of treatment providers. The authors argue that an understanding of these help-seeking pathways provides insights into ethnic group differences in mental health care utilization and that further research in this area is needed, (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of specialty mental health services by Asian Americans with psychiatric disorders.

Research suggests that Asian Americans underutilize mental health services but an understanding of the multiple factors involved in utilization has not been examined in a nationally representative sample. The current study analyzed data from the National Latino and Asian American Study (NLAAS) and examined 368 individuals with disorders to understand utilization and what factors were related to the utilization of specialty mental health services. Significant underutilization was found for Asian Americans; moreover, underutilization was especially acute among Asian American immigrants. For U.S.-born Asian Americans, use of primary care services was significantly associated with use of mental health services, but for foreign-born Asian Americans, use of primary care services was unrelated to mental health services use. For both U.S.-born and foreign-born Asian Americans, use of alternative services appeared to significantly affect whether Asian Americans with disorders utilize mental health services, but the nature of the influence varied depending on the individual’s level of English-language proficiency. These findings revealed that a major mental health disparity, the underutilization of mental health services by Asian Americans, was nuanced by use of other health-related services and immigration-related factors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Continuing education in cultural competence for community mental health practitioners.

Continuing education in cultural competence is a key strategy for enhancing provider effectiveness in working with culturally diverse clients. In the mental health field, a majority of published works address training issues related to students in graduate programs. Few articles, however, discuss specific models or methods of continuing education for practitioners working in community-based settings. The authors present a case example of an interactive workshop in cultural competence for community mental health practitioners. They discuss key modules of this workshop, including (a) cultural competence and outreach principles, (b) cultural identity and worldview, (c) stereotyping and automatic thinking, (d) dynamics of difference, and (e) application exercises. Recommendations are offered for administrators, direct care staff, trainers, and researchers who may be interested in undertaking or participating in cultural competence continuing education efforts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Barriers to mental health care utilization for U.S. Cambodian refugees.

Asian Americans encounter barriers to mental health care, some of which are structural, whereas others may be cultural. Using data from a probability sample (N = 490) drawn from the largest Cambodian refugee community in the United States, the authors assessed the extent to which structural and cultural barriers were experienced. Surprisingly, a relatively small proportion endorsed commonly cited cultural barriers such as distrust of Western care (4%) and greater confidence in alternative care (5%), whereas most endorsed structural barriers such as high cost (80%) and language (66%). Among those with a probable diagnosis, a similar pattern was found. Findings suggest that structural, not culturally based, barriers are the most critical obstacles to care in this U.S. Cambodian refugee community. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of familism in stress and coping processes among African American and White dementia caregivers: Effects on mental and physical health.

Objective: To explore how familism, burden, and coping styles mediate the relationships between ethnicity and the mental and physical health of caregivers. Design: A probability sample of 65 White and 95 African Americans respondents caring for an older family member with dementia was used to test hypotheses from a sociocultural stress and coping model using path analysis. Main outcome measures: Measures of caregivers' health included subjective health, self-reported diseases, blood pressure, and heart rate. Mental health measures included self-reported depression and psychological symptoms. Results: Contrary to the hypothesis, familism had an adverse effect on outcomes and was related to low education levels rather than to African American ethnicity. A buffering effect of active coping between being African American and diastolic blood pressure was found even after controlling for levels of education. Conclusions: Findings supported a core stress and coping model in which more behavior problems of care recipients were associated with poorer mental health of caregivers via greater burden and more use of avoidant coping. Results also demonstrate that this core model can be extended to physical health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward a cognitive process model of ethnic/racial biases in clinical judgment.

The purpose of the present article is to discuss approaches to the development of cognitive process models of misdiagnosis of African Americans, with particular emphasis on structured clinical interviews. Two basic approaches to cognitive process models are discussed. The first is cognitive bias based on prototype models of information processing. The second approach involves using the structured clinical interview to see how and when the decision-making process may be flawed, or where cognitive shifts are made in considering one diagnosis over another. Although routine training in structured clinical interviews may nullify cognitive biases associated with clinician judgment, it does not address cultural biases in the diagnostic system. It is concluded that a comprehensive approach to training in clinical decision making for mental health professionals is needed which include courses in the administration of the Structured Clinical Interview for DSM-IV, sociocultural case formulation, and cross-cultural sensitivity in making psychodiagnostic judgments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward cultural competence in child intake assessments.

As cultural diversity within the U.S. population increases, cultural competence in service delivery to children, youths, and families is a growing necessity. This article presents a process for integrating assessment of cultural data with the traditional intake assessment in children's mental health. The purpose and process of integrating cultural assessment throughout the child intake are presented. By using the cultural formulation guidelines proposed in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994), the content of a culture-integrated assessment is conceptualized and organized. The purpose of this article is to assist child, youth, and family psychologists with developing applied cultural competency skills in the context of the intake assessment with children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rethinking the concept of acculturation: Implications for theory and research.

This article presents an expanded model of acculturation among international migrants and their immediate descendants. Acculturation is proposed as a multidimensional process consisting of the confluence among heritage-cultural and receiving-cultural practices, values, and identifications. The implications of this reconceptualization for the acculturation construct, as well as for its relationship to psychosocial and health outcomes, are discussed. In particular, an expanded operationalization of acculturation is needed to address the “immigrant paradox,” whereby international migrants with more exposure to the receiving cultural context report poorer mental and physical health outcomes. We discuss the role of ethnicity, cultural similarity, and discrimination in the acculturation process, offer an operational definition for context of reception, and call for studies on the role that context of reception plays in the acculturation process. The new perspective on acculturation presented in this article is intended to yield a fuller understanding of complex acculturation processes and their relationships to contextual and individual functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bicultural self-efficacy among college students: Initial scale development and mental health correlates.

Theory and empirical research suggest that perceived self-efficacy, or one's perceived ability to perform personally significant tasks, is related to individuals' psychological well-being and mental health. Thus, the authors hypothesized that bicultural individuals' perceived ability to function competently in 2 cultures, or perceived bicultural self-efficacy, would be related positively to their psychological well-being and mental health. Three studies were conducted to develop and validate a measure of perceived bicultural self-efficacy and to explore its relationships with indices of psychological well-being and mental health. Exploratory (n = 268) and confirmatory (n = 164) factor analyses on the theoretically derived Bicultural Self-Efficacy Scale (BSES) items support a measurement model that taps into the 6 dimensions of bicultural competence proposed by T. LaFromboise, H. L. K. Coleman, and J. Gerton (1993). Furthermore, initial evidence for internal consistency (Studies 1, 2, and 3) and test–retest reliability (n = 51 Asian Americans) for each of the 6 subscales were found. Finally, perceived bicultural self-efficacy was found to be related to bicultural college students' psychological well-being and mental health. Research implications of the perceived bicultural self-efficacy construct and the potential utility of the BSES as a multidimensional measure of the construct are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

African American dreaming and the beast of racism: The cultural unconscious in Jungian analysis.

This article is an interpretation of the dream of an African American woman. The purpose is to discuss the contribution that contemporary Jungian analysis might make to the attempt by psychoanalysis to serve historically disenfranchised populations-- in particular, African Americans. The dreamer encounters racism in the image of a lion and other beasts. The interpretation takes into account both the archetypal level and the cultural level of the dream. Important concepts are the cultural unconscious and history-residues. The article argues that Jungian analysis-- as well as all other varieties of psychoanalysis-- will remain ineffective in addressing the concerns of disenfranchised populations until analysts make a serious effort to become culturally knowledgeable. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Citizens shaping policy: The Canadian Mental Health Association's framework for support project.

Fifteen plus years of work in mental health policy development from a community development perspective under the aegis of the Canadian Mental Health Association are described. The evolution of a model de-emphasizing formal mental health services and emphasizing partnerships between consumers, family members, the community at large, and mental health service providers is presented. Particular attention is paid to the value of re-investing in natural support systems both through the diversion of funds to such groups and the recognition of such systems as integral components of the cultural response to serious mental illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)