Transkulturelle Kompetenz: Spezialkompetenz oder psychotherapeutische Kernkompetenz?

Hintergrund

Es existieren zahlreiche theoretische Überlegungen dazu, was unter transkulturellen Kompetenzen von Psychotherapeuten zu verstehen ist. Die Frage, was sich jedoch Psychotherapeuten und Patienten selbst unter transkultureller Kompetenz vorstellen, ist bislang nicht untersucht worden. Unklar ist auch, inwiefern es sich bei transkultureller Kompetenz um eine Spezialkompetenz oder um eine Teilkomponente allgemeiner psychotherapeutischer Kernkompetenzen handelt.

Ziel der Arbeit

Die Studie geht der Frage nach, was sich Patienten und Psychotherapeuten unter transkultureller Kompetenz vorstellen, und ob es sich bei dieser Kompetenz um eine Spezialkompetenz oder um eine Teilkomponente allgemeiner psychotherapeutischer Kernkompetenzen handelt.

Material und Methoden

Zwölf problemzentrierte Interviews wurden leitfadengestützt mit Patienten mit Migrationshintergrund und Psychotherapeuten geführt und mithilfe der inhaltlich-strukturierenden qualitativen Inhaltsanalyse (Mayring 2008) ausgewertet.

Ergebnisse

Aus Sicht von Psychotherapeuten und Patienten bilden sich transkulturelle Kompetenzen in allgemeinen psychotherapeutischen Kernkompetenzen ab. Insbesondere das Eingehen auf die individuellen Anliegen der Patienten wurde als transkulturell kompetentes Handeln beschrieben.

Schlussfolgerung

Für die Entwicklung transkultureller Kompetenz bedarf es langfristiger Reflexionsprozesse und unmittelbarer Behandlungserfahrungen mit Patienten mit Migrationshintergrund. Diese Aspekte sollten in Konzeptionen für eine verbesserte Psychotherapeuten-Ausbildung berücksichtigt werden.

Provider Contributions to Disparities in Mental Health Care

OBJECTIVE

Disparities in diagnosis of mental health problems and in access to treatment among racial-ethnic groups are apparent across different behavioral conditions, particularly in the quality of treatment for depression. This study aimed to determine how much disparities differ across providers.

METHODS

Bayesian mixed-effects models were used to estimate whether disparities in patient adherence to antidepressant medication (N=331,776) or psychotherapy (N=275,095) were associated with specific providers. Models also tested whether providers who achieved greater adherence to treatment, on average, among non-Hispanic white patients than among patients from racial-ethnic minority groups attained lower disparities and whether the percentage of patients from racial-ethnic minority groups in a provider caseload was associated with disparities.

RESULTS

Disparities in adherence to both antidepressant medication and psychotherapy were associated with the provider. Provider performance with non-Hispanic white patients was negatively correlated with provider-specific disparities in adherence to psychotherapy but not to antidepressants. A higher proportion of patients from racial-ethnic minority groups in a provider's caseload was associated with lower adherence among non-Hispanic white patients, lower disparities in adherence to psychotherapy, and greater disparities in adherence to antidepressant medication.

CONCLUSIONS

Adherence to depression treatment among a provider's patients from racial-ethnic minority groups was related to adherence among that provider's non-Hispanic white patients, but evidence also suggested provider-specific disparities. Efforts among providers to decrease disparities might focus on improving the general skill of providers who treat more patients from racial-ethnic minority groups as well as offering culturally based training to providers with notable disparities.

Construct Validation in Counseling Psychology Research

Counseling psychology researchers devote little attention to theory-based measurement validation, as evidenced by cursory mention of validity issues in the method and discussion sections of published research reports. Especially, many researchers appear unaware of the limitations of correlations between pairs of self-report measures as evidence of construct validity. The authors provide an overview of the process of construct validation via user-friendly terminology and examples, with special attention to aspects often neglected in counseling psychology research, including specific recommendations for design and interpretation of multimethod validity investigations.

Clients’ Perceptions of Multicultural Counseling Competence

This article presents a reaction to Pope-Davis et al.’s major contribution concerning the importance of obtaining clients’ perceptions of counselors’ multicultural competence. Implications of their research findings for counseling psychology training, practice, and research are discussed.

An Investigation of European American Therapists’ Approach to Counseling African American Clients

Interviews were conducted with 9 European American psychologists, asking them to recall their first 12 counseling sessions with a current or recent successful case with an African American client. Using consensual qualitative research (CQR) methodology, the psychologists revealed that they generally attended to differences in race between themselves and clients directly and openly within the first two sessions. This was done to acknowledge this difference and convey to the client comfort and trust; psychologists also intended to engender client trust and participation in therapy. The psychologists saw race as a central component to be discussed and continually attended to in establishing and maintaining a trusting and solid working relationship. They typically saw race-related issues as relevant to clients’ concerns. Despite wide variability in theoretical orientations and variety of client presenting problems, they typically reported using Rogerian core skills to engage the client and establish the relationship. However, they also reported using more culture-specific and sensitive interventions to deepen and strengthen the therapy relationship. These interventions included relying on their level of racial identity development to understand the client, being attuned to the client’s racial identity development and worldview, and attending to client reports of racism.

Multicultural competencies: What are we measuring?

The current study examined the validity of the client-rated version of the Cross-Cultural Counseling Inventory-Revised (CCCI-R). The first phase of this study involved a content validation of the CCCI-R by experts who had publications in the fields of multicultural competencies (MCCs) and psychotherapy research. Of the 20 items on the CCCI-R, 7 were rated as appropriate for client use. The second phase of this study utilized confirmatory factor analysis to examine construct validity by testing whether clients' perceptions of their therapists' MCCs (via the seven items validated by experts) were distinct from client-rated working alliance scores. Model fit statistics supported a theoretically based model in which MCCs were measured distinctly from working alliance, but where the two factors were related. Implications for theory and practice are discussed.

Psychotherapy expertise in Singapore: A qualitative investigation

Personal characteristics, developmental influences, and therapy practices of nine peer-nominated expert psychotherapists practicing in the diverse country of Singapore were identified using qualitative methods. Sixteen themes were organized within four categories: (a) personal characteristics (empathic, nonjudgmental, respectful); (b) developmental influences (experience, self-awareness, humility, self-doubt); (c) approach to practice (balance between support and challenge, flexible therapeutic stance, empowerment/strength-based approach, primacy of the therapeutic alliance, comfortable addressing spirituality, embraces working within a multicultural context); and (d) ongoing professional growth (professional development practices, benefits of teaching/training others, challenges to professional development in Singapore). Cross-cultural comparisons between this study and Jennings and Skovholt's (1999) study of Minnesota expert psychotherapists found considerable overlap of themes. Implications for research and practice of psychotherapy are offered.

I was being myself but being an actor too: the experience of a Black male in interracial psychotherapy

In recent years, investigators have indicated that the psychotherapy process is of considerable importance in the context of interracial psychotherapy. Despite the interest in the area, minimal research has examined how racial difference impacts the psychotherapy process. This study examines the lived experience of interracial psychodynamic psychotherapy via an in-depth interview with an African-American man who had been in therapy with a European American therapist. This qualitative study utilizes a hermeneutic phenomenological approach, which accepts that understanding is contingent on both sociohistorical situatedness and relational dynamics. The study participant was chosen because of his interest in the area and willingness to explore it in detail with the interviewer. A number of themes emerged, the most salient of which are the multidimensionality of the experience and the 'absent presence' of race in the therapy process. This client's experience was both positive and negative, and in many cases, the same process-related variables contributed both positively and negatively to the client's therapeutic experience. Issues of trust, perceived cultural issues and therapy focus contributed to and detracted from the therapy experience. The depth of the therapy experience was limited by the therapist not explicitly addressing race.

Clients' ratings of counselor multicultural competency

Differences in perceptions between Euro American and ethnic minority respondents were examined to compare the role of counselor multicultural competency in multicultural versus traditional counseling. Results showed a strong positive correlation between clients' ratings of counselors' multicultural competencies and clients' ratings of counselors' general competency and empathy. However, when comparisons were made between Euro American and ethnic minority clients' on satisfaction, counselor multicultural competency explained a large and significant amount of variance for the ethnic minority sample only, above and beyond counselor general competency and empathy. Results are discussed in the context of relevant literature and suggestions for future research.

What's missing from multicultural competency research: review, introspection, and recommendations

Much of the multicultural counseling research has pointed out the need for counselors to become culturally competent to appropriately address the needs of an emerging diverse community. To date, however, this body of research has largely focused on counselor competencies, with little attention being given to the client perspective of multicultural counseling competencies. This article discusses the importance of integrating the client perspective within the historical context of the multicultural literature by examining client preferences and expectations, as well as the adequacy of the current empirical data. The authors also raise the issue of politics inherent in multiculturalism and discuss how this affects the research. A number of recommendations are made as a guide for future research.