Clients' ratings of counselor multicultural competency

Need for training or already OnTracc? Development and psychometric properties of an online transcultural competence questionnaire among psychotherapists

The prevalence of mental disorders among people with migration experiences is high. Studies have shown that despite the increasing number of patients from different cultures requiring therapy, treating them is still a major challenge. Furthermore, professional training aimed at improving transcultural competence is rare, and psychometric instruments assessing transcultural competence require improvement. Accordingly, this study aimed to develop and evaluate an online transcultural competence questionnaire (OnTracc) to assess transcultural competence among psychotherapists. Based on extensive literature research and expert interviews, 38-self-report statements referring to aspects of transcultural therapy (e.g., skills, knowledge, and awareness) were compiled. In two studies, 306 psychotherapists completed the OnTracc questionnaire. The multicultural counseling inventory (MCI), personality factors (BFI-K), experience in transcultural therapy, and demographic data were assessed as control variables. The exploratory factor analysis (EFA) revealed a 3-factor structure. The reliability of the scale ranged from ω = 0.73 to 0.81. These scales demonstrated substantial convergent and discriminant validity with the BFI-K and MCI subscales. Factorial validity was confirmed through confirmatory factor analysis. This validated inventory is the first to assess transcultural competence in therapeutic settings in the German language. Further analysis of the factorial validity of the different samples is recommended. Given the increasing diversity in the therapeutic landscape, additional development could help close the gap between the evolving treatment demands of culturally diverse patients and the lack of consideration in mental health and education.

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.

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).

Who’s Multiculturally Competent? Everybody and Nobody: A Multimethod Examination

This study was a social dominance theory-driven multimethod investigation of multicultural competence. Given the concerns with self-report, we examined the relationship between study variables and both self-report and performance-based multicultural competence. We also tested competing hypotheses regarding the relationship between the multicultural competence measures. We examined two samples: one of counselor trainees ( N = 93), and one of practicing therapists ( N = 107). The overwhelming performance floor effect in the context of self-report ceiling effects was striking and unexpected in its severity. Awareness of privilege was the most consistent predictor, and the only variable related to most multicultural competence measures. Results related to social dominance orientation, just-world beliefs, and empathy differed by sample. A key finding was the failure by a substantial proportion of participants in both samples to even minimally address clients’ sociocultural context. Thus, we focus our discussion on the implications of this result.

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.

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.

Look to the relationship: a review of African American women substance users' poor treatment retention and working alliance development

Emergent findings specific to African American women confirm that their substance user treatment retention rates are significantly lower than other groups, which is problematic given that substance user treatment is effective largely to the extent that clients are retained in treatment. This article reviews existing literature concerning disparities in treatment retention, highlights a significant barrier to treatment retention for this population, and presents support for an empirical focus on culturally responsive working alliance development as a promising step toward improving retention rates for African American women substance users.

Racial differences in satisfaction with mental health services among victims of intimate partner violence

Research on mental health among victims of intimate partner violence (IPV) has often ignored racial minorities. As the US population has become more racially diverse, the dearth of research on racial minorities' experience with current mental health systems makes it challenging for service providers and practitioners to serve them adequately. This study hypothesized that satisfaction with mental health services would be different across race in both the general population and among IPV victims. This study used the Collaborative Psychiatric Epidemiology Surveys. Logistic regression analyses were conducted. The study results revealed racial differences in satisfaction only in the IPV group. Race had effects on perceived helpfulness among IPV victims. Asian victims of IPV were more likely to perceive mental health services as helpful than any other race groups. Financial security had a positive effect both on subjective satisfaction and perceived helpfulness among IPV victims.

Making cross-racial therapy work: A phenomenological study of clients' experiences of cross-racial therapy

A phenomenological/consensual qualitative study of clients' lived experiences of cross-racial therapy was conducted to enhance our understanding of whether, how, and under what conditions race matters in the therapy relationship. The sample consisted of 16 racial/ethnic minority clients who received treatment from 16 White, European American therapists across a range of treatment settings. Participants who reported a satisfying experience of cross-racial therapy (n=8) were examined in relation to gender- and in most cases, race/ethnicity-matched controls (n=8) who reported an overall unsatisfying experience. Therapy satisfaction was assessed during the screening process and confirmed during the research interview. Therapy narratives were analyzed using consensual qualitative research to identify the client, therapist, and relational factors that distinguished satisfied from unsatisfied cases. Findings reveal substantial differences at the level of individual characteristics and relational processes, providing evidence of both universal (etic) as well as culture/context-specific (emic) aspects of healing relationships. Recommendations for facilitating positive alliance formation in cross-racial therapy are provided based on clients' descriptions of facilitative conditions in the therapy relationship.

Ethnic Matching Between Therapist and Patient in Psychotherapy: An Overview of Findings, Together With Methodological and Conceptual Issues

This article reviews the empirical support for ethnic matching between therapist and patient in psychotherapy. The research has 3 sources: analog studies, archival studies of number of attended sessions and dropout rates, and process-outcome studies of psychotherapy. Clinical trials studying ethnic matching are absent. Empirical support for ethnic matching suffers from low validity and is inconclusive, with few studies of actual psychotherapy. The research is hampered by poor conceptualization of key concepts, difficulties in forming ethnically homogeneous groups for comparisons, and an abundance of uncontrolled within-group variables. Therapist variables, for example cultural sensitivity, are rarely investigated. There is a need for large-scale psychotherapy studies with well-defined key concepts in which the impacts of within-group and therapist variables are investigated.

Individual and cultural-diversity competency: focus on the therapist

The Competencies Conference: Future Directions in Education and Credentialing in Professional Psychology was held in Arizona in November 2002. One of the workshops, Individual and Cultural Differences (ICD), focused on racism, homophobia, and ageism. The consensus was that self-awareness and knowledge about the three "isms" are critical components in the education and training of psychologists. This article, authored by four of the workshop attendees, is a review of the current research and theoretical literature. Implications that address both content and context in graduate programs and training sites are presented. This is one of a series of articles published in this issue of the Journal of Clinical Psychology. Several other articles that resulted from the Competencies Conference will appear in Professional Psychology: Research and Practice and The Counseling Psychologist.

Changes in satisfaction with mental health services among blacks, whites, and Hispanics in the Department of Veterans Affairs

This paper presents an analysis of changes in satisfaction of minorities with inpatient mental health services provided by the Veterans Health Administration (VHA) during a period of major system change (1995-2001). Post discharge data from 16,223 veterans who received inpatient VHA mental healthservices at 87 medical centers during this period was examined using hierarchical linear models. Blacks were found to have higher satisfaction levels on most measures over the period of study while the satisfaction of whites and Hispanics were not significantly different. There was little change over the study period in the relative satisfaction of minorities and whites. Changes in patterns of VHA mental health care have not adversely affected the satisfaction of minority veterans.