FUNDAMENTALS IN CLINICAL PSYCHOLOGY

CHAPTER 4: DIVERSITY AND CULTURAL ISSUES

IN CLINICAL PSYCHOLOGY

Prepared by:
Mrs. Josephine F. Santonia
 LEARNING OBJECTIVES
1. Describe professional efforts in clinical psychology that
demonstrate the field’s current focus on multiculturalism.
2. Speculate how cultural competence could be
demonstrated with psychotherapy clients of various
backgrounds.
3. Compare major perspectives on the similarities and
differences among people.
4. Explain ways that culture can be defined in the context
of clinical psychology.
5. Describe methods for training clinical psychologists in
cultural issues.
 THE RISE OF MULTICULTURALISM IN
CLINICAL PSYCHOLOGY
➢ The Diversification of the U.S. Population

➢ Multiculturalism as the “Fourth Force”

➢ Professional Efforts to Emphasize Issues of Diversity

➢ Journals and Books

 EMERGENCE OF AMERICAN PSYCHOLOGICAL
ASSOCIATION DIVISIONS
 Division 35—Society for the Psychology of Women
 Division 36—Society for the Psychology of Religion and
Spirituality
 Division44—Society for the Psychology of Sexual Orientation
and Gender Diversity
 Division 45—Society for the Psychological Study of Culture,
Ethnicity, and Race
 Division 51—Society for the Psychological Study of Men and
Masculinities
 Division 52—International Psychology
AMERICAN PSYCHOLOGICAL ASSOCIATION ETHICAL CODE

Principle E; Respect for People’s Rights and Dignity

Psychologists respect the dignity and worth of all
people, and the rights of individuals to privacy,
confidentiality, and self-determination.
- to protect the rights and welfare of persons or
communities
- respect cultural, individual, and role
differences.
- to eliminate the effect on their work of biases
AMERICAN PSYCHOLOGICAL ASSOCIATION ETHICAL CODE
Standard 2.01 Boundaries of Competence
Where scientific or professional knowledge in the
discipline of psychology establishes that an
understanding of factors associated with age, gender,
gender identity, race, ethnicity, culture, national origin,
religion, sexual orientation, disability, language, or
socioeconomic status is essential for effective
implementation of their services or research,
psychologists have or obtain the training, experience,
consultation, or supervision necessary to ensure the
competence of their services, or they make appropriate
referrals, except as provided in Standard 2.02, Providing
Services in Emergencies.
AMERICAN PSYCHOLOGICAL ASSOCIATION ETHICAL CODE

Standard 3.01 Unfair Discrimination

➢In their work-related activities, psychologists do
not engage in unfair discrimination based on
age, gender, gender identity, race, ethnicity,
culture, national origin, religion, sexual
orientation, disability, socioeconomic status, or
any basis prescribed by law.
AMERICAN PSYCHOLOGICAL ASSOCIATION ETHICAL CODE

Standard 9.06 Interpreting Assessment Results

 Psychologists take into account the purpose of the
assessment as well as the various test factors, test-taking
abilities, and other characteristics of the person being
assessed, such as situational, personal, linguistic, and
cultural differences, that might affect psychologists’
judgments or reduce the accuracy of their interpretations.
 They indicate any significant limitations of their
interpretations.
 “Commitment to Cultural and Individual
Differences and Diversity” (APA, 2015)

one of the five principles that guide the accreditation

decision.
applies
to doctoral programs, predoctoral internships,
and postdoctoral internships seeking accreditation.
thisprinciple, including but not limited to age, disability,
ethnicity, gender, gender identity, language, national
origin, race, religion, culture, sexual orientation, and
socioeconomic status.
 DSM EFFORTS TOWARD MULTICULTURALISM
DSM-5
 statein the Introduction that “key aspects of culture relevant to
diagnostic classification and assessment have been considered in
the development of DSM-5”
 information on cultural variation embedded in the descriptions of
specific disorders, it provides more general guidance for clinicians to
help with overall cultural competence.
 recent editions of DSM offer an “Outline for Cultural Formulation,”
 also offer a “Cultural Formulation Interview,”
 effort toward cultural awareness incorporated into DSM-5 and DSM-
5-TR is a glossary listing cultural concepts of distress
 “Culture-bound syndromes”

 taijinkyofusho, in which a person anxiously avoids interpersonal

situations because they believe that their appearance, actions, or
odor will offend other people (found in Japanese and some other
cultures);
 susto,in which a frightening event is thought to cause the soul to leave
the body, resulting in depressive symptoms (found in some Latinx
cultures); and
 maladi dyab, in which one person can “send” psychological problems
like depression and psychosis to another, often with the help of
another person believed to have special powers, (found in some
Haitian communities; similar experiences called the “evil eye” are more
common in other parts of the world).
 CULTURAL COMPETENCE

According to Sue et al. (2022), clinicians should strive to

acquire three capabilities to achieve multicultural
competence: awareness, knowledge, and skills.
1. Cultural Self-Awareness
➢ unique and idiosyncratic
➢ cultural humility
 CULTURAL COMPETENCE
2. Knowledge of Diverse Groups
➢ appreciatesthe cultural group norms but also
appreciates the heterogeneity inherent in every culture.
➢ dynamic sizing “double appreciation”
➢ heterogeneity

➢ Stems from different acculturation:

➢ assimilation,

➢ separation,

➢ marginalization, and
➢ integration
 CULTURAL COMPETENCE
Considering Culture: Interviews With Multicultural Experts: Cultural
Competence With Clients From Specific Cultural Groups
➢ Knowledge of diverse cultures is one of the core elements of cultural
competence.
➢ Experts in multicultural mental health to provide five questions about
clinical work with their cultural groups:
1. In general, why is it important for clinical psychologists to be culturally competent when
working with members of this culture?
2. What can a clinical psychologist do to enhance their cultural competence with members
of this culture?
3. What specific considerations should clinical psychologists keep in mind when conducting
assessments and diagnoses with members of this culture?
4. What specific considerations should clinical psychologists keep in mind when conducting
psychotherapy with members of this culture?
5. Any other thoughts about culturally competent practice with members of this culture?
 CULTURAL COMPETENCE

Latinx Clients
Dr. Melba Vasquez is the cofounder of the Society for the
Psychological Study of Culture, Ethnicity and Race (American
Psychological Association Division 45), the first Latina member-at-
large on the board of directors of the American Psychological
Association, and the 2011 president of the American
Psychological Association.
Black Clients
Dr. Robert L. Williams was a founding member of the National
Association of Black Psychologists in 1968. From 1970 to 1992, he
served as Full Professor of Psychology and African and African-
American Studies at Washington University in St. Louis.
 Some highly respected experts in
multicultural mental health
 Latinx Clients Dr. Melba Vasquez
 Asian and Asian American Clients Dr. Frederick Leong
 Native North American Clients Dr. Joseph E. Trimble
 Black Clients Dr. Robert L. Williams
 Irish American Clients Dr. Monica McGoldrick
 Women Clients Dr. Nadya A. Fouad
 Middle Eastern Clients Dr. Karen Haboush
 LGBTQ+ Clients Dr. Kathleen J. Bieschke
 Jewish American Clients Dr. Lewis Z. Schlosser
 CULTURAL COMPETENCE

3. Culturally Appropriate Clinical Skills

As the psychologist has gained cultural knowledge
of themselves and their clients, the next step is to
develop suitable strategies for assessment and treatment.
The approaches and techniques that a
psychologist uses to improve a client’s life should be
consistent with the values and life experience of that
client.
 CULTURAL COMPETENCE
3. Culturally Appropriate Clinical Skills
 Microaggressions

are comments or actions made in a cross-cultural

context that convey prejudicial, negative, or
stereotypical beliefs and may suggest dominance or
superiority of one group over another
 Cultural adaptation
how those treatments might need to be
adapted for members of diverse cultures
The Parent-Child Relationship
 ARE WE ALL ALIKE? OR ALL DIFFERENT?

➢Etic Versus Emic Perspective

➢ Derived from the terms phonetic (common to all) and
phonemic (specific).
➢ Etic - emphasizes the similarities between all people.
➢ Emic - emphasizes culture-specific norms.
 Tripartite Model of Personal Identity

Tripartite
model of personal identity in which all levels
hold some degree of importance.
Individual level- every person is like no other
person (uniqueness).
Group level- every person is like some other
people (similarities with a group).
Universal level- every person is like all other
people (shared human traits).
 WHAT CONSTITUTES A CULTURE?

Narrow Versus Broad Definitions

Subcultures
The ADDRESSING model (Pamela Hays)
intersectionality
TRAINING PSYCHOLOGISTS IN ISSUES OF
DIVERSITY AND CULTURE
Educational Alternatives
To date, no single best practice or consensus
exists regarding how psychologists should be trained in
cultural competence.
Measuring the Outcome of Culture-Based
Training Efforts
 Measuring the Outcome of Culture-Based
Training Efforts
Some of the difficult methodological questions:
 Howshould we reliably and validly measure the outcome of culture-
based training efforts?
 How can we reliably and validly establish a baseline for the level of
cultural competence of a psychologist or trainee before the training
takes place?
 When we assess the cultural competence element of psychotherapy,
whose opinion should we seek? The clients? The psychologists? The
supervisors? other interested parties?
 How can we make a causal connection between particular culture-
based training efforts and particular outcomes? How can we be sure
that confounding or unexamined variables aren’t responsible for the
outcomes we observe?