Mujeres abnegadas: The influence of gender expectations on the psychiatric encounter in Mexico

Theories on the cause of mental and emotional distress contribute to illness course and treatment. The theorizing of women's experience "as problem" has been widely critiqued by feminist psychologists yet continues in clinical practice. This qualitative study reports on data collected in a psychiatric outpatient clinic in south/central Mexico on the culturally embedded causal theories of mental illness among Mexican patients, a family member or caregiver, and their psychiatrists. The author reports on the influence of gender expectations and the view of "women as problem" in Mexico. Specifically, stakeholders considered that the idea of "mujeres abnegadas" (self-sacrificing women) was the cause of illness in female patients diagnosed with depressive or anxiety-related disorders. In the face of gendered violence and abuse, Mexican women were expected to be silent and submissive, to suppress their thoughts and feelings, and to endure ("aguantar") their experiences to conform to gender-based expectations, and psychiatrists expressed little hope of alleviating women's suffering. The author discusses her findings in the context of broader sociocultural factors and globalizing forces in psychological theory and practice and provides future directions to help de-pathologize patients' distress, broaden awareness of the contextual forces that influence distress, and galvanize appropriate resources and support.

Perceptions of mental health and perceived barriers to mental health help-seeking amongst refugees: A systematic review

Despite elevated rates of psychological disorders amongst individuals from a refugee background, levels of mental health help-seeking in these populations are low. There is an urgent need to understand the key barriers that prevent refugees and asylum-seekers from accessing help for psychological symptoms. This review synthesises literature examining perceptions of mental health and barriers to mental health help-seeking in individuals from a refugee background. Our analysis, which complies with PRISMA reporting guidelines, identified 62 relevant studies. Data extraction and thematic analytic techniques were used to synthesise findings from quantitative (n = 26) and qualitative (n = 40) studies. We found that the salient barriers to help-seeking were: (a) cultural barriers, including mental health stigma and knowledge of dominant models of mental health; (b) structural barriers, including financial strain, language proficiency, unstable accommodation, and a lack of understanding of how to access services, and (c) barriers specific to the refugee experience, including immigration status, a lack of trust in authority figures and concerns about confidentiality. We discuss and contextualise these key themes and consider how these findings can inform the development of policies and programs to increase treatment uptake and ultimately reduce the mental health burden amongst refugees and asylum-seekers.

Counseling Psychology and the Amelioration of Oppression: Translating Our Knowledge Into Action

In the new millennium, counseling psychologists have answered the call to address oppression related to intersectional identities. We have played a major role in the development of practice guidelines and policies, as well as in the application of ethical principles in cultural contexts. The Counseling Psychologist has served to disseminate information addressing needs and interventions for diverse communities. In this article, we review the history and impact of our efforts to ameliorate oppression. The pressing challenges of economic and educational disparities are highlighted along with how counseling psychologists are uniquely situated to meet the needs of the underserved. Our research, training, and practice are anchored in methodological pluralism, global helping paradigms, participatory engagement, and the promotion of liberation and radical healing. We offer recommendations to deconstruct current models and reconstruct a decolonized approach, embrace interdisciplinary collaboration to fight cultural encapsulation, strengthen prevention and advocacy, train a culturally diverse workforce, and prioritize intersectional research.

Rogers’s Person-Centered Approach: Consideration for Use in Multicultural Counseling

To provide competent counseling services to an increasingly diverse clientele, attention must be given to the applicability of the dominant theoretical orientations. Rogers’s person-centered approach is widely used, but the appropriateness of its diverse applications should not be assumed. This article considers the applicability of Rogers’s person-centered approach in multicultural counseling contexts.

Hope and Humor: Using the Hope Scale in Outcome Studies

Hope has been identified as a factor measured by the Hope Scale to evaluate effectiveness of treatment in outcome studies. Hope is defined as a goal-oriented cognitive construct comprised of two components, (a) the Pathways component is the individual's sense of planning strategies to reach goals and (b) the Agency component is the individual's determination to implement these goal-focused strategies. Using a Solomon Four-Group design, the relationship of the Hope Scale pretest to the posttest scores was evaluated. This study also explored the use of humor (a source of hope) in elevating total Hope Scale scores, the Agency component scores, and the Pathways component scores. 80 undergraduate students (57 women, 23 men) were ran domly assigned to one of four groups. Analysis indicated that administering the Hope Scale prior to treatment was not significantly associated with posttest scores, and the one-time 15-min. exposure to the humor intervention of reading Far Side comics was not sufficient to elevate scores on the Hope Scale.

Multidimensional Facets of Cultural Competence

Calls for incorporating cultural competence in psychology have been hindered for a number of reasons: belief in the universality of psychological laws and theories, the invisibility of monocultural policies and practices, differences over defining cultural competence, and the lack of a conceptual framework for organizing its multifaceted dimensions. A proposed multidimensional model of cultural competence (MDCC) incorporates three primary dimensions: (a) racial and culture-specific attributes of competence, (b) components of cultural competence, and (c) foci of cultural competence. Based on a 3 (Awareness, Knowledge, and Skills) × 4 (Individual, Professional, Organizational, and Societal) × 5 (African American, Asian American, Latino/Hispanic American, Native American, and European American) factorial combination, the MDCC allows for the systematic identification of cultural competence in a number of different areas. Its uses in education and training, practice, and research are discussed.

Houston, 2001

This article presents an overview of the Houston 2001 National Counseling Psychology Conference. The authors discuss the context for the 4th National Counseling Psychology Conference, documentthe process of decision makingaboutthe conference, andexamine the content of the conference. The authors also examine a unique feature of the conference, the social action groups, discussing their philosophical underpinnings as well as how they were organized, what took place, and recommendations drawn from the groups. The authors evaluatethe outcomes of the Houston Conference andalso assess the conference within the context of the legacy of the three other counseling psychology conferences held at Northwestern University in 1951, in the Greyston Conference Center at Teachers College in 1964, and in Atlanta in 1987. Finally, the authors make recommendations for the field to move the conference’s initiatives forward and plan for future conferences.

Social Desirability Attitudes, Sex, and Affective and Cognitive Empathy as Predictors of Self-Reported Multicultural Counseling Competence

This study explored the relative contributions of social desirability attitudes, sex, and affective and cognitive empathy to self-reported multicultural counseling competence. Using the Knowledge and Awareness subscales of the Multicultural Counseling Knowledge and Awareness Scale as criterion variables, two 3-step forced entry multiple regression analyses revealed that both sex and affective and cognitive empathy were significant predictors of self-reported multicultural counseling competence. Implications of the findings are discussed.

Current Status and Anticipated Changes in Psychology Internships

This article briefly traces the history of psychology internship training to its central role in professional training in counseling psychology. Current issues are discussed, including supply and demand, increased applicant costs, timing of internship, and escalation of practicum training hours. Future considerations are outlined, including point of licensure, length of training, postdoctoral training, and preparation of students to meet demands of the next biennium. Training for the full range of human diversity and creating new employment opportunities for counseling psychologists are emphasized.

Qualitative Research Methods

This article extends the Pope-Davis et al. contribution by focusing on the emerging position of qualitative research methods in counseling psychology. Strengths of the Pope-Davis study are highlighted, and suggestions for research and training are presented.

Exploring the Academic Achievement and Career Aspirations of College-Bound and Postsecondary Zulu Students

This article reports on a qualitative approach used to identify developmental and contextual factors associated with academic success and career aspirations of 13 Black Zulu South African students transitioning into college or in their first year of college. Students were queried on their aspirations and values, definitions of success, and barriers/enablers to school completion. The most dominant core idea related to the central role of family as a support. Other core ideas included a desire to succeed in school and a concern about having the necessary skills to do so. A commitment to academic/career success appeared disconnected from concrete future goals and plans for many students, suggesting the need for improved social support networks that promote academic achievement and career opportunities. The emergence of both traditional, affiliative values and the desire for individual achievement and success was significant. Results reinforce the importance of culturally sensitive and relevant constructs to achieve academic and career success.

Client Perspectives of Multicultural Counseling Competence

Multicultural competence is a burgeoning area of research in counseling psychology. However, there has been little focus on understanding multicultural competence from the perspective of clients. This study used qualitative interviews and grounded theory to develop a model of clients’ perspectives of multicultural counseling. The resulting model suggested that clients’ experiences of multicultural counseling were contingent on their self-identified needs and on how well they felt the counselor met these needs. Moreover, clients appeared to actively manage and moderate the extent to which culture was broached in counseling based on a host of conditions including counseling relationship, salience of identity, counselor behavior, and expectations of counseling, to name a few. Implications for future research and practice are discussed.

Counseling Psychology and School Counseling

Counseling psychology and school counseling have become quite removed from each other despite sharing a common history, having similar values, and the fact that many training programs for the two disciplines coexist in the same university department or college. This article argues for a stronger integration of the two specialties to advance their contributions to pre–K-12 education and the nation’s youth. Counseling psychology, with its strong commitment to career psychology, counselor training and supervision, multiculturalism, prevention, and scientific inquiry, is well positioned among psychological specialties to exert major influence in the educational enterprise. Models of school counselor training and service delivery have been recently developed and offer numerous opportunities for collaboration between counseling psychologists and school counselors. A collaborative model that encompasses training curricula, research, service, and professional organization dimensions of the specialties is presented. Challenges that may impede a stronger partnership between counseling psychology and school counseling, as well as suggestions for addressing them, are also discussed.

Theory and Research on Stereotypes and Perceptual Bias

This article presents theory and selected research on stereotyping and cognitive automaticity as a didactic resource base for multicultural counselor educators. Multicultural trainers can use this information in the classroom to establish the existing scientific evidence indicating that perceptual processes taking place outside of conscious awareness give rise to biased perceptions involving racial or ethnic categories. The objective of this didactic resource is to impress upon counseling trainees the importance of coming to terms with racial prejudice and biases often hidden from conscious scrutiny. In addition to the didactic material, several experiential exercises designed to elicit awareness of biases in personal attitudes and beliefs toward culturally diverse groups are presented. Suggestions for future research are also included.

Mental Health Diagnostic Considerations in Racial/Ethnic Minority Youth

Misdiagnoses of racial/ethnic minority youth's mental health problems can potentially contribute to inappropriate mental health care. Therefore, we conducted a systematic review that focuses on current theory and empirical research in an attempt to answer the following two questions: 1) What evidence exists that supports or contradicts the idea that racial/ethnic minority youth's mental health problems are misdiagnosed? 2) What are the sources of misdiagnoses? Articles were reviewed from 1967 to 2014 using PsychINFO, PubMed, and GoogleScholar. Search terms included "race", "ethnicity", "minority", "culture", "children", "youth", "adolescents", "mental health", "psychopathology", "diagnosis", "misdiagnosis", "miscategorization", "underdiagnosis", and "overdiagnosis". Seventy-two articles and book chapters met criteria and were included in this review. Overall, evidence was found that supports the possibility of misdiagnosis of ethnic minority youth's emotional and behavioral problems. However, the evidence is limited such that it cannot be determined whether racial/ethnic differences are due to differences in psychopathology, mental health biases, and/or inaccurate diagnoses. Cultural and contextual factors that may influence misdiagnosis as well as recommendations for research and practice are discussed.

Shifting perspectives: culturally responsive interventions with latino substance abusers

In 2001, there were 35 million Latinos living in the United States. It is estimated that by 2050 Latinos will comprise 97 million people in the United States, or one-fourth of the U.S. population, establishing this ethnic group as the fastest growing and soon to be largest in the country (U.S. Census Bureau, 2001 ). These numbers highlight the need for a multicultural paradigm shift, or the inclusion of culture-specific skills and culturally responsive interventions in psychological practice. Latinos face challenges as a racial/ethnic group that the traditional Euro-American model of treatment neither addresses nor validates. Unfortunately, substance abuse serves a purposeful function for many Latinos as a means of escape from the problems related to the social, environmental, and political structures. The current article adapts the model set forth by Parham ( 2002 ) as a strength-based therapeutic framework for intervention. The following stages are outlined to serve as the basis for most therapeutic encounters with clients from all racial and ethnic groups presenting with substance abuse problems: therapeutic alliance building, culturally appropriate assessment, sociopolitical awareness and liberation, creating collaborative change, and addressing sustainability of change.

The Culturally-Enhanced Videofeedback Engagement (CEVE) Framework: Qualitative findings in families of children with disruptive behavior problems

While cultural competence has been promoted as a way to reduce mental health disparities among ethnic minority populations, there remains a gap between theory and practice. This study examined the use of the Culturally Enhanced Videofeedback Engagement (CEVE) intervention as a clinical tool to facilitate culturally anchored shared understanding to foster treatment engagement among ethnic minority families with children with disruptive behavior disorders (DBDs) participating in a family clinic. In-depth qualitative analysis of individual interviews compared parents' experiences of the therapy process among 9 intervention families and 10 families participating in treatment as usual. Thematic analysis of semistructured interviews with parents revealed that for families in the intervention group, clinician cultural and clinical competence and the therapeutic relationship were important characteristics of the intervention condition that enhanced parents' experience of treatment.

The Cultural Ecogram: A Tool for Enhancing Culturally Anchored Shared Understanding in the Treatment of Ethnic Minority Families

Ethnic and racial disparities in mental health care continue to exist, highlighting the increasing concern within the realm of clinical practice as to how clinicians are to effectively integrate the central role of culture and context into the treatment delivery process for culturally diverse children and families. The current paper presents the Cultural Ecogram, - a clinical engagement tool designed to facilitate the development of a culturally anchored shared understanding - as one method that may facilitate clinician-client shared understanding on the client's cultural, ethnic and racial context central to the effective implementation of treatments with ethnic minority children and families.

The weight-inclusive versus weight-normative approach to health: evaluating the evidence for prioritizing well-being over weight loss

Using an ethical lens, this review evaluates two methods of working within patient care and public health: the weight-normative approach (emphasis on weight and weight loss when defining health and well-being) and the weight-inclusive approach (emphasis on viewing health and well-being as multifaceted while directing efforts toward improving health access and reducing weight stigma). Data reveal that the weight-normative approach is not effective for most people because of high rates of weight regain and cycling from weight loss interventions, which are linked to adverse health and well-being. Its predominant focus on weight may also foster stigma in health care and society, and data show that weight stigma is also linked to adverse health and well-being. In contrast, data support a weight-inclusive approach, which is included in models such as Health at Every Size for improving physical (e.g., blood pressure), behavioral (e.g., binge eating), and psychological (e.g., depression) indices, as well as acceptability of public health messages. Therefore, the weight-inclusive approach upholds nonmaleficience and beneficience, whereas the weight-normative approach does not. We offer a theoretical framework that organizes the research included in this review and discuss how it can guide research efforts and help health professionals intervene with their patients and community.

Depression among Asian Americans: Review and Recommendations

This article presents a review of the prevalence and manifestation of depression among Asian Americans and discusses some of the existing issues in the assessment and diagnosis of depression among Asian Americans. The authors point out the diversity and increasing numbers of Asian Americans and the need to provide better mental health services for this population. While the prevalence of depression among Asian Americans is lower than that among other ethnic/racial groups, Asian Americans receive treatment for depression less often and its quality is less adequate. In addition, the previous belief that Asians somatize depression may become obsolete as more evidence appears to support that Westerners may "psychologize" depression. The cultural validity of the current DSM-IV conceptualization of depression is questioned. In the course of the review, the theme of complexity emerges: the heterogeneity of ethnic Asian American groups, the multidimensionality of depression, and the intersectionality of multiple factors among depressed Asian Americans.

Client Motivation and Multicultural Counseling

This reaction article comments on the major contribution titled “Motivation and Autonomy in Counseling, Psychotherapy, and Behavior Change: A Look at Theory and Practice.” It first points out the article’s strengths, the primary of which was to move the construct of motivation to the center of focus in the discussion of counseling. In addition, the exploration of how motivation is conceptualized within each of the major theoretical schools of thought was illuminating. This reaction article also attempts to expand the discussion of motivation into the arena of multicultural counseling. One of the main efforts in multicultural counseling is to increase the utility of counseling services among racial and ethnic minorities and hence understanding the role of motivation is central. This reaction article explores the role of motivation in help-seeking behavior and offers ways in which motivation could be enhanced so that counseling services will be more frequently and better utilized.

Extending boundaries: clinical communication with culturally and linguistically diverse mental health clients and carers

We are often confronted with the dilemmas of interacting with people from different cultural backgrounds. How do we ensure that we meet their needs, if they have some barriers to communicating those needs? This project explores the communication mechanisms used by mental health clinicians, to explore how they modify their communication to reconcile cultural differences and promote self-disclosure. It also identifies the practical experiences that have enlightened clinicians' practice when interacting with culturally and linguistically diverse (CALD) groups. Through focus groups, mental health clinicians were probed about their experiences with CALD groups and the methods used to facilitate communication. Clinicians were working in either acute adult inpatient or community settings in a large metropolitan health service. Fifty-three clinicians formed 7 focus groups. In the focus groups, clinicians were asked about their perceptions of communication with CALD clients. Guided questions were used. All focus groups were audio-taped and transcribed. Two distinct themes emerged. They were 'respect' and 'cultural understanding'. The clinicians recognized that showing and maintaining respect for the CALD client, and their families significantly impacted on the development of a therapeutic relationship. Showing cultural understanding and acceptance for difference also enhanced communication.

Cross-Cultural Assessment and Management in Primary Care

The increasing number of culturally diverse patients in primary care and the demands to provide culturally sensitive health care make it essential that physicians provide care that is responsive to a culturally diverse population. Physicians must use cross-cultural techniques in their assessment and management practices. The cross-culturally competent physician has the potential to increase his or her ability to provide effective and culturally responsive treatment to a wider spectrum of patients, resulting in more positive treatment outcomes.

Asian and Pacific Island American students' acculturation and etiology beliefs about typical counseling presenting problems

Asian American Pacific Island college students (N = 93) completed measures of acculturation and mental health worldview, in the form of beliefs about the likely causes of 24 typical counseling presenting problems. A criterion sample of 27 staff from 2 university counseling centers reported their beliefs about the most likely cause of the same 24 problems for a typical client. A response similarity index was calculated, with higher scores reflecting greater similarity between student and counselor mental health worldviews. Results suggest that higher acculturation was associated with greater level of match between the students' etiology beliefs and those of counselors. The greatest differences were observed for serious personal problems, whereas there was more belief convergence about causes of academic problems.