syndrome (young, attractive, verbal, intelligent, and
successful). However, numerous reviews of existing
research have concluded that there appears to be
virtually no relationship between social class and
outcome (Garfield, 1994). What has not been
examined in great detail is whether patients and
therapists should be matched according to social
class or whether some forms of psychotherapy are
more effective than others for patients from lower
socioeconomic levels.
When there is a significant difference between
the social class or the values of the patient and those
of the therapist, some researchers have found that
the patient’s willingness to remain in therapy may
suffer (Zane et al., 2004). Few would disagree that
cultural sensitivityon the part of the therapist is very
important. The field needs to develop culturally
sensitive mental health services (Sue et al., 1994;
Zane et al., 2004). Clinicians also need to develop
a kind of cognitive empathy, or what Scott and
Borodovsky (1990) have referred to as cultural
role-taking, in their work with ethnic minorities.
In the final analysis, it is imperative that clinical
psychology develop culturally sensitive therapists
who can work effectively with culturally diverse
populations (Paniagua, 1998).Therapists’Reactions to Patients. In the best of
all worlds, it would make no difference whether or
not the patient was an engaging person who elicitedBOX11-3 Focus on Professional Issues: Cultural CompetenceIncreasingly, clinical psychologists are providing
services to members of non-White multicultural
groups. Therefore, the clinician must consider a
number of factors when assessing and treating
clients from an ethnic or socioeconomic group
different from his or her own. Paniagua (1998)
provides a number of general guidelines and
considerations:- Acculturation. This refers to“the degree of inte-
gration of new cultural patterns into the original
cultural patterns”(Paniagua, 1998, p. 8). Accul-
turation can be internal (e.g., moving from one
region of the United States to another) or exter-
nal (moving to a new country). Clinicians can esti-
mate the level of acculturation exhibited by a
client by administering brief scales that assess
variables like language preference, preferred
racial group with which to socialize, and genera-
tion (Paniagua, 1998). - Language Barriers. Although it is ideal to avoid
the use of a translator if at all possible, in some
cases a translator is necessary. Paniagua (1998)
suggests using translators who share the client’s
cultural background. Translators should have a
background in mental health and should develop
some rapport with the client ahead of time.
A sequential mode of translation should be used
(versus concurrent translation), and the use of
friends, relatives, and bilingual children as trans-
lators should be avoided. The level of accultura-
tion of the translator should be considered as
well.- Overdiagnosis. Clinicians must guard against
inaccurately viewing behaviors of members
of multicultural groups as pathological
simply because these are unfamiliar or
unusual. - Extended Family. Clinicians should rely on
the client’s definition of extended family
(which may include nonbiological members)
before enlisting others to aid in the client’s
treatment. - Type of Theory. Directive, active, and structured
therapies are generally preferred by African
Americans, Native Americans, Hispanics, and Asian
Americans. Individual therapy should precede any
family or marital therapy in instances where
acculturation appears to play a major role in the
presenting problems. - AmountofDataCollected. Clinicians should
avoid collecting massive amounts of data early
on in the assessment or treatment process. Oth-
erwise, members of multicultural groups may
view this as a sign of incompetence and gross
unfamiliarity with their respective cultures. Data
should be gathered gradually across multiple
sessions.
324 CHAPTER 11