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.


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

  • 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


Akutsu, P. D., Lin, C. H., & Zane, N. W. S. (1990). Predictors of utilization intent of counseling among Chinese and White students: A test of the proximal-distal model. Journal of Counseling Psychology, 37, 445-452.

Atkinson, D. R., & Lowe, S. M. (1995). The role of ethnicity, cultural knowledge, and conventional techniques in counseling and psychotherapy. Ponterotto, J. G., Casas, J. M., Suzuki, L. A., Alexander, C. M. (Eds.). Handbook of multicultural counseling (387-414). Thousand Oaks, CA: Sage.

Berg, J. H., & Wright-Buckley (1988). Effects of racial similarity and interviewer intimacy in a peer counseling analogue. Journal of Counseling Psychology, 35, 377-384.

Borrego, R. L., Chavez, E. L., & Titley, R. W. (1982). Effects of therapist techniques on Mexican-American and Anglo-American self-disclosure and therapist perception. Journal of Counseling Psychology, 29, 538-541.

Bradford, D. T., & Munoz, A. (1993). Translation in bilingual psychotherapy. Professional Psychology: Research and Practice, 24, 52-61.

Beutler, L., Machado, P., & Neufelt. S. (1994). Therapist variables. In A. E. Bergin & S. L. Garfield (Eds.). Handbook of psychotherapy change (4th. ed.) (pp 229-269). New York: Wiley

Cannon, C. B. (1983). Using an interpreter in cross-cultural counseling. School Therapist, 31, 11-16.

Carter, R. T. & Helms, J. E. (1992). The counseling process as defined by relationship types: A test of Helms’ interaction model. Journal of Multicultural Counseling and Development, 20, 181-201.

Comas-Diaz, L. (1981). Effects of cognitive and behavioral group treatment on the depressive symptomatology of Puerto Rican women. Journal of Consulting and Clinical Psychology, 49, 627-632.

Comaz-Diaz L., & Jacobsen, F. A. (1995). Ethnocultural transference and countertransference in the therapeutic dyad. American Journal of Orthopsychiatry, 61, 392-402.

Constantine, M. G. (in press a). Predictors of observer ratings of multicultural counseling competence in trainees. Journal of Counseling Psychology.

Constantine, M. G. (in press b). Predictors of satisfaction with counseling: Racial and ethnic minority clients’ attitudes toward counseling and ratings of their therapists’ general and multicultural counseling competence. Journal of Counseling Psychology.

Constantine, M. G., & Ladany, N. (2000). Self-report multicultural counseling competence scales: Their relation to social desirability attitudes and multicultural case conceptualization ability. Journal of Counseling Psychology, 47, 155-164.

Constantino, G., Malgady, R. G., & Rogler, L. H. (1986). Cuento therapy: A culturally sensitive modality for Puerto Rican children. Journal of Consulting and Clinical Psychology, 54, 639-645.

Cook, D. A., & Helms, J. E. (1988). Visible racial/ethnic group supervisees’ satisfaction with cross-cultural supervision as predicated by relationship characteristics. Journal of Counseling Psychology, 35, 268-274.

D’ Andrea, M., Daniels, J., & Heck, R. (1991). Evaluating the impact of multicultural counseling training. Journal of Counseling and Development, 70, 143-150.

Dauphinais, P., Dauphinais, L., & Rowe, W. (1981). Effects of race and communication style on Indian perceptions of therapist effectiveness. Therapist Education and Supervision, 21, 72-80.

Fishman, Y. (1998). Metaclinical issues in the treatment of psychopolitical trauma. American Journal of Orthopsychiatry, 68, 27-38.

Frame, M. W., Williams, C. B., & Green, E. L. (1999). Balm in Gilead: Spiritual dimensions in counseling African American women. Journal of Multicultural Counseling and Development, 27, 182-192.

Franklin, A. J. (1999). Invisibility syndrome and racial identity development in psychotherapy and counseling African American men. The Counseling Psychologist, 27, 76-793.

Fuertes, J. N., & Brobst, K. (in press). Clients perspectives of therapist multicultural competence. Cultural Diversity and Ethnic Minority Psychology.

Garfield, S. L. (1994). Research on client variables in psychotherapy. In A. E. Bergin & S. L. Garfield (Eds.). Handbook of psychotherapy behavior change (4th ed.) (pp. 190-228). New York: John Wiley & Sons.

Gong-Guy, E., Cravens, R. B., & Patterson, T. E. (1991). Clinical issues in mental health service delivery to refugees. American Psychologist, 46, 642-648.

Greene B. (1995). African American women. In L. Comaz-Diaz & B. Greene (Eds.), Women of color: Integrating ethnic and gender identities in psychotherapy (pp. 10-29). New York: Guilford Press.

Gushue, G. V., & Carter, R. T. (2000). Remembering Race: White racial identity attitudes and two aspects of social memory. Journal of Counseling Psychology, 47, 155-164.

Helms, J. E., & Carter, R. T. (1991). Relationships of White and Black racial identity attiudes and demographic similarity to therapist preferences.Journal of Counseling Psychology, 38, 446-457.

Ibrahim, F. A. (1985). Effective cross-cultural counseling and psychotherapy: A framework. The Counseling Psychologist, 13, 625-683.

Ihle G. M., Sodowsky, G. R., & Kwan, K. L. (1996). Worldviews of women Comparisons between White American clients, White American therapists, and Chinese international students. Journal of Counseling and Development, 74, 300-306.

Ivey , A. E. (1995). Psychotherapy as liberation: Toward specific skills and strategies in multicultural counseling and therapy. In J. G. Ponterotto, J. M. Casas, L.A. Suzuki, C. A. Alexander (Eds.), Handbook of multicultural counseling Thousand Oaks, CA: SAGE.

Katz, J. H. (1985). The sociopolitical nature of counseling. The Counseling Psychologist, 13, 615-624.

Keyes, K. L. (1989). The therapist’s role in helping students with limited English proficiency. School Therapist, 37, 144-148.

Korsgaard, C. (1990). Acculturation: Intragroup differences in the choice of gender and ethnicity of a therapist in an Asian American population. Unpublished doctoral dissertation, California School of Professional Psychology.

Kunkel, M. A. (1990). Expectations about counseling in relation to acculturation in Mexican-American and Anglo-American student samples. Journal of Counseling Psychology, 37, 286-292.

LaFromboise, T.D. (1992). An interpersonal analysis of affinity, clarification, and helping responses with American Indians. Professional Psychology: Research And Practice, 23, 281-286.

LaFromboise, T. D., Coleman, H. L., & Hernandez, A. (1991). Development and factor structure of the Cross-Cultural Counseling Inventory-Revised. Professional Psychology: Research & Practice, 22, 380-388.

LaFromboise, T. D., & Dixon, D. N. (1981). American Indian perception of trustworthiness in a counseling review. Journal of Counseling Psychology, 28, 135-139.

Leong, F. T. L. (1986). Counseling and psychotherapy with Asian-Americans: Review of the literature. Journal of Counseling Psychology, 33, 196-206.

LeVine, E. S., & Franco, J. N. (1983). Effects of therapist’s gender, ethnicity, and verbal style on client’s willingness to seek therapy. Journal of Social Psychology, 121, 51-57.

Luk, C. L., & Bond, M. H. (1992). Chinese lay beliefs about the causes and cures of psychological problems. Journal of Social and Clinical Psychology, 11, 140-157.

Martinez, R. P., & Holloway, E. L. (1997). The supervision relationship in multicultural training. In D. B. Pope-Davis, & L. K. H. Coleman (Eds.), Multicultural counseling competencies: Assessment, education and training, and supervision (pp 325-349). Thousand Oaks, CA: SAGE.

Maultsby, M. C. (1982). A historical view of Blacks’ mistrust of psychiatry. In S. M. Turner & R. T. Jones (Eds.), Behavior modification in Black populations:Psychosocial issues and empirical findings (pp. 39