The association of socioeconomic status with the success of chat-based online counseling for children and youth: A latent change score modeling approach

Children and youth from lower subjective socioeconomic status (SES) backgrounds are at a heightened risk of mental disorders. Online counseling is a valuable tool to reach those less likely to seek professional help, but its success across different SES backgrounds remains unclear. This study explores the association between subjective SES and online counseling outcomes. Children and youth (N = 2139) between 10 and 24 years-of-age received chat-based online counseling and reported on SES, negative feelings before and after the chat, and perceived helpfulness of the chat via an online assessment tool. The results of a latent change score model showed a significant association between SES and negative feelings before chatting, indicating that lower SES predicted more negative feelings (r = -0.26, p < .001). Further, SES was indirectly associated with the change in negative feelings from before to after counseling, mediated by the extent of negative feelings before the chat (β = 0.07, 95%CFI = [0.05-0.10]). Current findings extend research on online counseling programs in the context of SES. Despite higher counseling needs among low SES individuals, they do not benefit proportionally from existing online services in this sample. Future research should investigate barriers to help-seeking and implement specialized counselor training programs.

University students' intentions to seek psychological counseling, attitudes toward seeking psychological help, and stigma

BACKGROUND

Mental health problems are prevalent among university students worldwide. Studies have shown that most students do not disclose and do not get the psychological help and support they need.

OBJECTIVES

This survey aims to investigate the intentions to seek psychological counseling (ISC) among university students, their attitudes toward seeking professional psychological help (ATSPPH), and the predictors of those intentions and attitudes including stigma.

DESIGN AND METHODS

a cross-sectional survey was conducted among 420 students at the American University of Beirut (AUB).

RESULTS

Depression, test anxiety, and difficulty sleeping are the three main reasons students would seek psychological help. The source the students most preferred to ask for help was one's family followed by psychologists and psychiatrists. Students' ATSPPH is a positive predictor of their ISC, while students' self-stigma of seeking help (SSOSH) is a negative predictor of their ATSPPH. Moreover, students' awareness of the psychological help system available on campus, free of charge, is a positive predictor for both ISC and ATSPPH.

CONCLUSION

Different interventions are needed to reduce stigma and enhance students' mental health literacy and awareness of the available professional psychological help on campus.

Exploring the association between mental health climate and depression: the protective role of positive mental health and sense of belonging among Black college students

Objective: To explore relationships between mental health climate, positive mental health, sense of belonging, and depression among a U.S. national sample of Black college students. Participants: 1303 Black undergraduate and graduate students from 15 colleges and universities throughout the U.S. Methods: Data were from the 2018-2019 Healthy Minds Study. Analysis included hierarchical regression models. Results: A more positive perception of mental health climate and higher levels of both positive mental health and sense of belonging were significantly associated with lower levels of depression. Significant interactions existed between positive mental health and climate and sense of belonging and climate with buffering effects being most pronounced for students reporting high levels of positive mental health. Conclusion: Black college students' perceptions of an institution's mental health climate are associated with psychological outcomes. College health stakeholders should consider the buffering effects of protective factors on mental health when designing initiatives for Black college students.

Measuring physicians’ religious competence in clinical health communication context: female Muslim immigrant patients’ expectations

Purpose

This exploratory study aims to examine female Muslim immigrant patients’ expectations of physicians’ religious competence during clinical interactions.

Design/methodology/approach

In total, 101 female Muslim immigrants in Ottawa, Canada, completed an eight-item survey measuring patients’ expectations of physicians’ religious competence during clinical communication.

Findings

Results from the independent samples t-tests and one-way ANOVA suggested that female Muslim immigrant patients in this study expected their doctors to be aware of Islam as a religion and be sensitive to their religious needs, especially food/dietary practices during clinical communication. Although the participants did not differ in their expectations of physicians’ religious competence based on age, educational level, employment status and income level, they differed based on their frequencies of visiting doctors and their ethnic/cultural origin.

Originality/value

This study fills a gap in the literature by advancing understanding of religious competence during clinical interactions from female Muslim immigrant patients’ perspective. The findings can contribute to developing religiously competent and accessible health-care services for religiously diverse populations.

Multicultural Competence as a Common Factor in the Process and Outcome of Counseling

Much research has been conducted on multicultural competence (MCC) over the past four decades, though there is still a need to conduct further research into the role of MCC within actual counseling relationships and in relation to additional variables. The present survey study was designed to better elaborate on the relationship between MCC and several common factor therapy and outcome variables within counseling relationships. Findings indicated that MCC was more strongly correlated with all measured variables (except perceived change) within counseling relationships where client and/or counselor identified as BIPOC than in White–White client counselor dyads. MCC was associated with higher ratings on the other measured variables regardless of client–counselor race or ethnicity. Finally, path analysis supported a model where MCC (a therapist factor) influenced process factors, which in turn influenced therapeutic outcomes. The results provide support for the importance of MCC to the process and outcome of counseling, particularly for BIPOC clients.

White and non-White Australian mental health care practitioners' desirable responding, cultural competence, and racial/ethnic attitudes

Background

Racial, ethnic, religious, and cultural diversity in Australia is rapidly increasing. Although Indigenous Australians account for only approximately 3.5% of the country’s population, over 50% of Australians were born overseas or have at least one migrant parent. Migration accounts for over 60% of Australia’s population growth, with migration from Asia, Sub-Saharan African and the Americas increasing by 500% in the last decade. Little is known about Australian mental health care practitioners’ attitudes toward this diversity and their level of cultural competence.

Aim

Given the relationship between practitioner cultural competence and the mental health outcomes of non-White clients, this study aimed to identify factors that influence non-White and White practitioners’ cultural competence.

Methods

An online questionnaire was completed by 139 Australian mental health practitioners. The measures included: the Balanced Inventory of Desirable Responding (BIDR); the Multicultural Counselling Inventory (MCI); and the Color-blind Racial Attitudes Scale (CoBRAS). Descriptive statistics were used to summarise participants’ demographic characteristics. One-way ANOVA and Kruskal–Wallis tests were conducted to identify between-group differences (non-White compared to White practitioners) in cultural competence and racial and ethnic blindness. Correlation analyses were conducted to determine the association between participants’ gender or age and cultural competence. Hierarchical multiple regression analysis was conducted to predict cultural competence.

Results

The study demonstrates that non-White mental health practitioners are more culturally aware and have better multicultural counselling relationships with non-White people than their White counterparts. Higher MCI total scores (measuring cultural competence) were associated with older age, greater attendance of cultural competence-related trainings and increased awareness of general and pervasive racial and/or ethnic discrimination. Practitioners with higher MCI total scores were also likely to think more highly of themselves (e.g., have higher self-deceptive positive enhancement scores on the BIDR) than those with lower MCI total scores.

Conclusion

The findings highlight that the current one-size-fits-all and skills-development approach to cultural competence training ignores the significant role that practitioner diversity and differences play. The recommendations from this study can inform clinical educators and supervisors about the importance of continuing professional development relevant to practitioners’ age, racial/ethnic background and practitioner engagement with prior cultural competence training.

Older adults’ mental health information preferences: a call for more balanced information to empower older adults’ mental health help-seeking

A small minority of older adults seek psychological help when they need it. Barriers to mental health service use among older adults include low mental health literacy and reduced opportunities for shared decision-making in health care. There is a gap in the literature examining the mental health information preferences of older adults. The objectives of this study were to describe the information preferences and predictors of preferences among older adults. In total, 229 adults aged 50 years and older in central Canada responded to a questionnaire investigating socio-demographic, psycho-social and health-related characteristics, as well as mental health information preferences. Descriptive analysis quantified participants’ ratings of information preferences and hierarchical linear regression analysis determined predictors of their preferences. Older adults rated all mental health content items as very important. Most participants preferred detailed information (two to six pages) on all treatment options (psychological, pharmacological, combined and self-help). Older adults significantly preferred discussion with a heath-care provider and written information, in comparison to other formats. Older adults also significantly preferred to consult family, friends and heath-care professionals over other sources. Socio-demographic and psycho-social characteristics accounted for some of the variance in predicting older adults’ information preferences. Findings highlight older adults’ desire to be involved in decisions concerning mental health supports. Providing balanced information concerning mental health treatment may increase empowerment in mental health help-seeking.

Community providers' experiences with evidence-based practices: The role of therapist race/ethnicity

OBJECTIVES

Examining therapists' experiences implementing evidence-based practices (EBPs) is fundamental to understanding how these interventions are perceived, adapted, and delivered in community settings. However, little is known about racial/ethnic variation in the experiences of therapists serving racial/ethnic minority youth and their families. Through an innovative QUAN → qual → QUAN mixed-methods approach, we examined differences in therapists' perceptions, adaptations performed, and client-engagement challenges in the largest county-operated department of mental health in the United States.

METHOD

Surveys were completed by 743 therapists (Latinx [44%], White [34%], other ethnic minority [22%]), most of whom were female (88%), master's level (85%), and unlicensed (58%). A subset of therapists (n = 60) completed semistructured interviews.

RESULTS

Latinx therapists reported more positive experiences implementing EBPs, making more adaptations to EBPs, and encountering fewer client-engagement challenges than therapists from other racial/ethnic groups. Qualitative analyses expanded on these results, revealing that Latinx therapists commonly described adapting EBPs in terms of language and culture to improve fit and promote client engagement. Informed by these qualitative themes, a refined statistical model revealed that the ability to deliver EBPs in languages other than English might have accounted for differences in therapist-reported EBP adaptations and client-engagement challenges.

CONCLUSIONS

The findings suggest that racial/ethnic minority therapists have positive experiences in implementing EBPs in community settings. In the case of Latinx therapists, bilingual/bicultural competence may facilitate adapting EBPs in ways that reduce perceptions of engagement challenges with racially/ethnically diverse clients. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Understanding Initial and Sustained Engagement of Spanish-Speaking Latina Mothers in the Legacy for Children Program™: A Qualitative Examination of a Group-Based Parenting Program

Culturally congruent parenting programs delivered during early childhood have the potential to support diverse families. Legacy for Children™ (Legacy) is a group-based prevention program designed to promote child development by reinforcing sensitive, responsive mother-child relationships, building maternal self-efficacy, and fostering peer networks of support among mothers living in poverty (Perou et al., 2012). The Legacy program was translated and culturally adapted for Spanish-speaking Latina mothers and their infants (hereafter referred to as Latina mothers) with a feasibility trial conducted to determine the cultural congruency of the adaptation. Feasibility results were positive with no previous studies validating the adapted Legacy Spanish language program (Legacy Spanish). The current manuscript focuses on understanding factors of engagement of the culturally adapted model. Specifically, we examined the factors that were perceived to have enhanced or hindered both initial and sustained engagement in the adapted Legacy Spanish program for Latina mothers. Individual interviews were conducted with Latina mothers (N=26) who attended the Legacy Spanish program. We used a template approach within NVivo 11^© software to identify broad themes in Latina mothers' responses. Themes emerged regarding the importance of using home-based recruitment strategies and pairing verbal information with written brochures to foster initial engagement. Sustained engagement themes focused on the provision of support from other Latina mothers in the Legacy group and the relationships with the group leaders. Having group leaders who were perceived as genuine, kind, positive, "good" at teaching, and persistent emerged as themes that facilitated initial and ongoing engagement. Barriers to engagement centered primarily on logistics rather than characteristics of the program itself. Thus, Latina mothers attributed importance to aspects of the curriculum, logistics, and implementation with respect to program engagement. Application of similar engagement strategies could enhance the success of early childhood parenting programs and linkages with early educational programming.

Cultural competency training in psychiatry

Recent reports indicate that the quality of care provided to immigrant and ethnic minority patients is not at the same level as that provided to majority group patients. Although the European Board of Medical Specialists recognizes awareness of cultural issues as a core component of the psychiatry specialization, few medical schools provide training in cultural issues. Cultural competence represents a comprehensive response to the mental health care needs of immigrant and ethnic minority patients. Cultural competence training involves the development of knowledge, skills, and attitudes that can improve the effectiveness of psychiatric treatment. Cognitive cultural competence involves awareness of the various ways in which culture, immigration status, and race impact psychosocial development, psychopathology, and therapeutic transactions. Technical cultural competence involves the application of cognitive cultural competence, and requires proficiency in intercultural communication, the capacity to develop a therapeutic relationship with a culturally different patient, and the ability to adapt diagnosis and treatment in response to cultural difference. Perhaps the greatest challenge in cultural competence training involves the development of attitudinal competence inasmuch as it requires exploration of cultural and racial preconceptions. Although research is in its infancy, there are increasing indications that cultural competence can improve key aspects of the psychiatric treatment of immigrant and minority group patients.

Cultural competence dimensions and outcomes: a systematic review of the literature

It has been widely suggested that cultural competence is an individual's core requirement for working effectively with culturally diverse people. However, there is no consensus regarding the definition or the components of this concept and there is a dearth of empirical proof indicating the benefits of cultural competence. Therefore, a systematic review was conducted to identify the most common cultural competence dimensions proposed in recent publications and to identify whether sufficient evidence exists regarding the efficacy of cultural competence in the healthcare context. A total of 1204 citations were identified through an electronic search of databases, of which 18 publications included cultural competence frameworks, and 13 studies contained empirical data on cultural competence outcomes. The overarching themes of the review were centred around the challenges faced by the healthcare sector in many countries due to growing cultural diversity, but lack of cultural competence, leading to predicaments that arise during intercultural interactions between patients and clinicians. This review will benefit researchers exploring cultural competence as one of the research variables impacting research outcomes.

Africentric Cultural Values, Psychological Help-Seeking Attitudes, and Self-Concealment in African American College Students

This study investigated the relationships among Africentric cultural values (i.e., the extent to which an individual adheres to a worldview emphasizing communalism, unity, harmony, spirituality, and authenticity), favorable psychological help-seeking attitudes, perceived counseling stigma, and selfconcealment (i.e., the tendency to withhold personal, sensitive information that is perceived as negative or upsetting) in a sample of African American college students. The authors found that for both African American women and men, higher degrees of Africentric cultural values were associated with greater perceived stigma about counseling and greater self-concealment. In addition, findings indicated that neither favorable psychological help-seeking attitudes nor perceived counseling stigma significantly mediated the relationship between Africentric cultural values and self-concealment behavior. Implication of the findings and future research directions are discussed.

“It's Not What I Expected”

Although estimates are that only about half of youth mentoring relationships established through formal programs last beyond a few months, almost no attention has been paid to understanding mentoring relationship failures. In-depth semistructured interviews were conducted with 20 adult and 11 adolescent male and female participants in a community-based one-to-one mentoring program whose relationships ended early. Line-by-line coding and a narrative approach to a thematic analysis of the interview transcripts yielded six salient factors that contributed to the demise of these mentoring relationships: (a) mentor or protégé abandonment, (b) perceived lack of protégé motivation, (c) unfulfilled expectations, (d) deficiencies in mentor relational skills, including the inability to bridge cultural divides, (e) family interference, and (f) inadequate agency support.

Spirituality, Connectedness, and Beliefs About Psychological Services Among Filipino Immigrants in Iceland

The authors examined psychological help-seeking attitudes and intentions of 183 Filipino immigrants in Iceland who had no previous counseling experience. Using path analysis, the authors examined how Filipino immigrants’ connectedness to the Filipino and Icelandic communities mediated the relationship among length of stay in Iceland, Icelandic and English fluency, spirituality, and psychological help-seeking attitudes and intentions. The authors also assessed the relationship between perceived system barriers and psychological help seeking. Filipino immigrants’ sense of connectedness to Icelandic society mediated the relationship among length of stay, Icelandic fluency, spirituality, and expertness beliefs and help-seeking intentions. Connectedness to the Filipino community in Iceland mediated the relationship between English fluency and stigma tolerance. Greater perception of system barriers was related to lower tolerance for the stigma attached to seeking psychological help. Implications and suggestions for further research are discussed.

Factors Contributing to Optimal Human Functioning in People of Color in the United States

Many conceptualizations of optimal human functioning are based on Western European notions of healthy and unhealthy development and daily living. When applied to people of color in the United States, however, these conceptualizations may prove inapplicable because of their Western culture–bound nature. The authors explore the role that cultural values, beliefs, and practices play in definitions of optimal functioning and describe how overcoming adverse circumstances has resulted in the development of adaptive assets for people of color.

Ethnic differences in help-seeking behaviour following child sexual abuse: a multi-method study

In Western societies, groups from a minority ethnic background are under-represented in formal mental health care. However, it is unknown if the minority ethnic victims of child sexual abuse differ from majority ethnic victims regarding their help-seeking behaviours. This study used a multi-method design to investigate the prevalence of (in) formal help-seeking after child sexual abuse and the influence of attitudes towards gender roles and sexuality on help-seeking among the Dutch minority ethnic and majority ethnic victims. We also examined differences in reasons not to seek help. Quantitative survey data on help-seeking patterns among 1496 child sexual abuse victims were collected. Four qualitative focus groups were conducted with professionals working in the field of child sexual abuse and minority ethnic groups to explore help-seeking behaviour. No significant differences between ethnicity emerged in help-seeking rates. However, respondents with more liberal gender attitudes were more likely to disclose than conservative respondents. Additionally, an interaction effect was observed between ethnicity and gender attitudes, indicating that, contrary to the main effect, young people of Moroccan and Turkish heritage with more liberal gender attitudes were less likely to disclose abuse. Reasons for not seeking help differed among groups. Focus group members emphasised mistrust towards counsellors and perceptions that inhibit minority ethnic youth from seeking help.

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.

Exploring Indices of Disordered Eating Literacy in Male and Female Athletes: Knowledge Gaps and Lay Beliefs as Predictors of Attitudes Toward Help-Seeking

The aim of this pilot study was to explore disordered eating (DE) literacy in male and female athletes and to examine whether any gender differences were present. A related aim was to examine the moderating effect of gender on the relationship between indices of DE literacy and attitudes toward help-seeking for DE. A nonclinical sample of 133 (37% male) athletes from a variety of sports and competitive levels were recruited to complete an online questionnaire addressing a range of topics linked to DE literacy. Chi-square analysis indicated no significant gender differences on indicators of DE literacy. Findings from the survey revealed a number of beliefs conducive to low or inappropriate help-seeking for DE. The results highlight the importance of exploring DE literacy in athletes to develop more targeted interventions for this specific population.

THE INFLUENCE OF RACE AND ETHNICITY IN CLIENTS' EXPERIENCES OF MENTAL HEALTH TREATMENT

Clinicians and researchers have pointed to the need for culturally sensitive mental health interventions. Yet it has not been determined if the inclusion of cultural elements affects the way mental health clients experience services. This study examined 102 clients who had received mental health treatment from outpatient mental health clinics to investigate whether culturally related elements involving race and ethnicity were important to clients and whether they were related to client satisfaction and perceived treatment outcomes. Ethnic minority clients generally felt that issues regarding race and ethnicity were more important than did White clients. When these elements were considered important but were not included in their care, clients were less satisfied with treatment. Consistent with the notion of cultural responsiveness, these findings provide empirical evidence that culturally relevant aspects of the mental health service experience are salient to ethnic minority clients and can affect how they respond to services.

Bridging the gap for ethnic minority adult outpatients with depression and anxiety disorders by culturally adapted treatments

BACKGROUND

Culturally adapted guideline driven depression and anxiety treatments have been developed for ethnic minority patients in Western countries to boost effectiveness for these growing and vulnerable groups. The aims of this study are to systematically review the empirical literature of outcomes associated with culturally adapted guideline driven depression and anxiety interventions, to describe the cultural adaptation and to identify the contribution of the cultural adaptation and approach as such.

METHOD

Comprehensive search of the major bibliographical databases (Cochrane Central Register of Controlled Trials, Pubmed; Psychinfo) for randomized controlled trials.

RESULTS

Nine eligible studies were identified and all were conducted in the USA. The pooled random standardized differences in means of the culturally adapted depression and anxiety treatment on clinical outcome was 1.06 (CI 95% 0.51-1.62, P=0.00). Two studies demonstrated effectiveness of the population specific cultural adaptation per se. All studies incorporated a focus on cultural values and beliefs as a cultural adaptation.

LIMITATION

We only identified a small number of USA studies so generalisation of the findings to other western countries can be discussed.

CONCLUSION

Culturally adapted guideline driven depression and anxiety treatment was effective for USA minority patients from different cultural backgrounds. There is some evidence for the effectiveness of the population specific cultural adaptation as such.

Cross-Cultural Adaptation of the Icelandic Beliefs About Psychological Services Scale (I-BAPS)

Three studies are described on the cross-cultural adaptation of the Beliefs About Psychological Services scale for use in Iceland (I-BAPS). Emic and etic methods were used to enhance the instrument's cross-cultural validity. In Study 1, indigenous emic items were developed. In Studies 2 and 3, the dimensionality and psychometric properties of the instrument were evaluated. The I-BAPS contains 22 items (16 etic and 6 emic) distributed on three subscales: Intent, Stigma Tolerance, and Expertness, which provide a reliable and valid representation of Icelanders' attitudes toward and intentions to seek psychological services. It is expected that the I-BAPS will stimulate research on psychological help seeking in Iceland. It is also anticipated that the methods we used will inspire those interested in cross-cultural and cultural research to focus on validity enhancement of instruments for use outside their culture of origin.

A Person-Centered Approach to Multicultural Counseling Competence

This article examines current and historical trends in psychotherapy research and practice with racial/ethnic minority populations. Initially, research on Derald Sue’s multicultural counseling competencies is provided as a foundation to further examine the evidence regarding effective cultural adaptations to mainstream treatment approaches, such as cognitive-behavior therapy and interpersonal psychotherapy. Next, a brief outline of Carl Rogers’s psychotherapy research tradition is presented, with a focus on both past and present evidence suggesting that person-centered therapy may be effective across diagnoses, as well as cultures. Using psychotherapy evidence from both the latter half of the 20th century and the initial decades of the 21st century, cultural adaptations to previously hypothesized person-centered therapy mechanisms of change are proposed. In particular, this culturally adapted person-centered approach is suggested to provide a competent and effective treatment system for racial/ethnic minority clients and families.

The Association of Black Psychologists

The Association of Black Psychologists (ABPsi) was founded on September 2, 1968, in San Francisco, California, in response to the American Psychological Association’s failure to address the mental health needs of the Black community. This revolutionary idea was borne out of the efforts of Black early career psychologists and student activists from across the United States. ABPsi, as the first national ethnic psychological association, has led the field of psychology in the areas of racial/ethnic identity, cultural psychology, multicultural competencies, positive psychology, and social justice. ABPsi publishes a peer-reviewed journal ( Journal of Black Psychology) and a quarterly newsletter ( Psych Discourse). More recently, ABPsi has established a licensing, certification, and proficiency program in African-centered Black psychology. A brief history of ABPsi and its relationship to the field of counseling psychology is discussed.

System-level change in cultural and linguistic competence (CLC): how changes in CLC are related to service experience outcomes in systems of care

As US demographic trends shift toward more diversity, it becomes increasingly necessary to address differential needs of diverse groups of youth in mental health service systems. Cultural and linguistic competence (CLC) is essential to providing the most appropriate mental health services to youth and their families. The successful implementation of CLC often begins at the system level. Though various factors may affect change and system-level factors set the tone for broad acceptance of CLC within systems, there is limited empirical evidence linking culturally competent practices to outcomes. The purpose of the present study was to examine system-level CLC changes over time within systems of care and their associations with service experiences among youth and their families. Participants were 4,512 youth and their families enrolled in the national evaluation of the Children's Mental Health Initiative (CMHI). Results suggest that implementation of CLC at the system level improves over time in funded systems of care. Further, variation exists in specific system-level components of CLC. In addition, the changes in CLC at the system level are related to family/caregiver participation in treatment. Implications for supporting positive changes in CLC among systems of care communities, and specific strategies for community psychologists, are discussed.

Rethinking cultural competence: insights from indigenous community treatment settings

Multicultural professional psychologists routinely assert that psychotherapeutic interventions require culturally competent delivery for ethnoracial minority clients to protect the distinctive cultural orientations of these clients. Dominant disciplinary conceptualizations of cultural competence are "kind of person" models that emphasize specialized awareness, knowledge, and skills on the part of the practitioner. Even within psychology, this approach to cultural competence is controversial owing to professional misgivings concerning its culturally essentialist assumptions. Unfortunately, alternative "process-oriented" models of cultural competence emphasize such generic aspects of therapeutic interaction that they remain in danger of losing sight of culture altogether. Thus, for cultural competence to persist as a meaningful construct, an alternative approach that avoids both essentialism and generalism must be recovered. One means to capture this alternative is to shift focus away from culturally competent therapists toward culturally commensurate therapies. Indigenous communities in North America represent interesting sites for exploring this shift, owing to widespread political commitments to Aboriginal cultural reclamation in the context of postcoloniality. Two examples from indigenous communities illustrate a continuum of cultural commensurability that ranges from global psychotherapeutic approaches at one end to local healing traditions at the other. Location of culturally integrative efforts by indigenous communities along this continuum illustrates the possibility for local, agentic, and intentional deconstructions and reconstructions of mental health interventions in a culturally hybrid fashion.

Provider cultural competency, client satisfaction, and engagement in home-based programs to treat child abuse and neglect

Home-based programs to treat child abuse and neglect suffer from high rates of attrition, limiting their impact. Thus, research is needed to identify factors related to client engagement. Using data (N = 1,305) from a statewide family preservation program, this study investigated the role of program type (i.e., SafeCare(®) [SC] vs. Services as Usual [SAU]) and client perceived provider cultural competence on client satisfaction and engagement with services. Families in SC completed more treatment goals than those in SAU. In addition, provider cultural competence and client satisfaction were higher in SC than in SAU. Higher provider cultural competence was associated with higher goal attainment and satisfaction, and these effects partially mediated the service program differences. The effects of service type and cultural competence on goal attainment and satisfaction varied somewhat by client ethnicity. Findings suggest that clients receiving manualized programs for child maltreatment may be more likely to meet their goals and may perceive such programs to be culturally appropriate and satisfactory.

The effects of working alliance and client-clinician ethnic match on recovery status

Sixty-seven clients with severe and persistent mental illnesses (SPMI) recruited from community mental health centers were interviewed to assess their subjective quality of life, self-efficacy, importance of ethnic matching and level of working alliance (WA) with their clinicians. Results revealed that clients in the ethnically matched group reported significantly higher WA compared to the non-matched group. Clients who reported a higher level of WA also reported better recovery status. Results suggest that, in a multicultural community, ethnic matching may help augment WA and address potential barriers to treatment engagement, and identifying strategies to promote WA may enhance treatment effectiveness in programs for SPMI.