Multicultural Process and Outcome Research – Document 2

Roysircar, G., & Gard, G. (in press). Research in multicultural counseling: Impact of therapist variables on process and outcome. In C. C. Lee (Ed.), Multicultural issues in counseling: New approaches to diversity (3rd edition). Alexandria, VA: American Counseling Association.

Abstract

Historically, psychotherapy research has not examined adequately the impact of the therapist on the process and outcome of therapy. The authors of the paper, recognizing the significance of racial, ethnic, and cultural variables in client-therapist dynamics, present a 20-year literature review, from 1980 to the present time, throwing light on the following topic areas: the relative unimportance of racial and ethnic similarity between the client and the therapist; modification of mainstream methods that include directive techniques, empathy, and therapist self-disclosure; therapist cultural and racial awareness; therapist application of cultural knowledge; therapist recognition of dyadic racial dynamics; therapist interface with minority client mistrust; therapist bilingual response to non-English-speaking clients; and therapist multicultural competencies. Implications within each topic area are discussed. Clinical interpretations of research findings are offered on the basis of the authors’ extensive practice with immigrants of color. In a final section, multicultural counseling research is connected to the general psychotherapy outcome literature. A table provides a summary of the major themes, accompanied with representative references, developed in the paper.

Table 1:

Summary of Major Themes in Multicultural Research on Process and Outcome

Major Sections in This Paper
Introduction:

  • Multicultural competencies include general and multicultural skills, cultural self- and other-awareness, multicultural relationship, and cultural knowledge.
  • Clinical work with multicultural clients is not limited to individual and group modalities, but includes many forms of community-based and skills training interventions. These latter interventions are culturally consistent with the collectivistic approaches of many minorities.
  • Therapist-client ethnic and racial similarity is mediated by values and attitudes specifically related to acculturation, racial identity, or ethnic identity.

Modification of Mainstream Methods:

  • Three generic counseling skills most frequently adapted for use with multicultural clients are directiveness, empathy, and self-disclosure.
  • Knowing how to appropriately categorize experiences as cultural (inclusive) or individual (exclusive) is a skill- and knowledge-based multicultural competency sometimes referred to as “dynamic sizing” of the client.

Culturally Consistent Counseling: Therapist Response to Minority Client Presentations

  • Cultural responsiveness/sensitivity results from shared attitudes between therapist and client and is a better predictor of client ratings of satisfaction, empathy, unconditional regard, and therapist credibility than race.
  • As racial and ethnic minorities tend to be religious, it is important to remember that the degree of religious commitment is more important than the specific beliefs with regard to client coping and attitudes.
  • Therapists must have knowledge of the cultures that they work with and cannot expect their clients to educate them when it is the client that has come for help.
  • Research on racial dynamics in the counseling dyad suggests that the therapist must be aware of how both his/her own as well as the client’s racial identity affects the client.
  • The multiculturally competent therapist must be able to accurately assess and use interventions that are consistent with the racial identity development of the client.
  • With regard to minority client mistrust, seven therapist responses have been identified as potentially creating an atmosphere of distrust:
    1. an abrupt shift in topic;
    2. purposeful inaccurate paraphrasing;
    3. mood and interest change;
    4. a break in confidentiality;
    5. exposure of a hidden agenda;
    6. a stereotyping statement; and
    7. a broken promise.
  • Bilingual therapy with a translator should be culturally consistent, simultaneous with the client’s speech, and direct without any interpretation on the part of the translator. Further research in this area is warranted.
  • More research needs to be done in the area of how therapist use of cultural content impacts client attitudes and outcome. A potential downside to such research and culture-specific services is increasing segregation.

Assessment of Multicultural Counseling Competencies:

  • Since the mid-1990’s multicultural counseling competence has been increasingly recognized as impacting the validity of assessment, therapeutic alliance, and treatment effectiveness. The latter was of particular interest, given high rates of early termination and underutilization of treatment services by racial and ethnic minorities.
  • Muticultural training increases both self-reported or observer-reported ratings of multicultural counseling competencies.
  • Use of observer ratings of multicultural counseling competencies is a new development in this area.
  • Use of client ratings of therapist competencies is also a new development.
  • Assessment of multicultural therapist competencies remains ultimately an individual, self-reflective experience as the therapist must assess his/her own awareness of cultural influences, racial oppression, the sociopolitical nature of counseling, and similarity of values related to acculturation, racial and ethnic identity, and worldview with each new client of color.
  • Controlling for social desirability or multicultural social desirability in self-reported multicultural competencies is a current methodological practice.
  • Multicultural training curriculum and clinical practicum have a strong emphasis on therapist trainees and supervisees’ reflections on their personal biases which form a barrier between them and their minority clients. While observer ratings can provide a checklist of therapist behaviors, these cannot gauge therapists’ intrapersonal process.
  • The multicultural counseling relationship emphasizes the human element in therapist-client interactions, which can be described as “ethnotherapeutic empathy,” entailing the integration of “cultural knowledge with a dynamic experience of the client’s subjective culture.”
  • As the therapist commits to the process of multicultural self-awareness, power becomes a shared property of the multicultural relationship and not of one individual. In addition to shared power, involvement is an affiliative dimension that is integral to the relationship, carrying the meaning of forming intentional attachments, as each member uses the other as a source of self-affirmation, relating freely as individuals rather than in stereotyped roles.
  • The consistent findings in the general psychotherapy outcome literature demonstrate the broad generalizability of the multicultural research on process and outcome.

Copyright © Gargi Roysircar, Department of Clinical Psychology, Antioch University New England, 7/24/01

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