Mental health practitioners all over the world value cultural diversity, but it's not always easy to translate that respect into culturally-responsive services. CulturedPsychology.com is dedicated towards making practical, "how-to" information on culturally-tailored mental health services accessible to helping professionals. On this site, you will find resources that summarize the "take-home" messages of almost 200 peer-reviewed publications on culture and mental health.
Chinese philosopher Wang Yang Ming once stated "知行合一" that "knowledge and action go hand in hand". The author's hope is that these resources will empower helping professionals to put their knowledge and respect of culture into practice in new and exciting ways, to the benefit of their culturally diverse clients.
Why Tailor Services to Client Culture?
Professional Ethics & Respect for Diversity
Cultural responsiveness is consistent with our commitment towards respecting diversity, and is an important ethical and practical goal for helping professionals. This value is conveyed through the publication of ethical competency standards, for example, by the American Psychological Association (2002), Canadian Psychological Association (2001), and National Association of Social Workers (2001).
The Mental Health Disparity
In the United States and Canada, culturally-diverse people generally:
(See Kirmayer, du Fort, Young, Weinfeld, & Lasry, 1996; Melfi, Croghan, Hanna, & Robinson, 2000; Mok, Lao, Lin, Wong, & Ganesan, 2003; Snowden & Yamada, 2005; Stewart, 2008; U.S. Department of Health and Human Services, 2001; Wang et al., 2005).
Benefits of culturally-adapted therapy include:
(See Benish, Quinana & Wampold, 2011; Griner & Smith, 2006; Huey & Polo, 2008)
The effect size of culturally adapted therapy is estimated to be r=.22 (Griner & Smith, 2006; Huey & Polo, 2008; Smith, Domenech Rodrıguez, & Bernal, 2011), or even up to .25 when services were targeted to a single ethnic group or to less-acculturated clients. This compares well to other important elements of therapy such as the working alliance at approximately .25 (Safran & Muran, 2006) and theoretical orientation at up to .20 (Wampold et al., 1997). In other words, in a culturally-adapted program delivered to less-acculturated clients or designed for a specific ethnic group, the average participant typically does equal-or-better than 69% of clients receiving non-adapted therapy, and reports satisfaction levels equal-or-greater than 82% of clients recieving ordinary services!
Therefore, we may consider culturally adapting therapy as comparably beneficial to strong relationship building and careful selection of theoretical orientation.
Adapted From/Suggested Citation:
Rapacki, T. M., & McBride, D. L. (2014, July). From awareness to practice: An online workshop on bringing culture into the counselling room. Retrieved from ERIC database. (ED545469). [Available at: http://files.eric.ed.gov/fulltext/ED545469.pdf]
American Psychological Association. (APA). (2002). Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. Washington, DC: Author.
Benish, S. G., Quintana, S., & Wampold, B. E. (2011). Culturally adapted psychotherapy and the legitimacy of myth: A direct-comparison meta-analysis. Journal of Counseling Psychology, 58, 279–289. doi:10.1037/a0023626
Canadian Psychological Association. (CPA). (2001). Guidelines for non-discriminatory practice. Retrieved from: www.cpa.ca/cpasite/userfiles/Documents/publications/NonDiscPractrev%20cpa.pdf
Griner, D., & Smith, T. B. (2006). Culturally adapted mental health intervention: A meta-analytic review. Psychotherapy: Theory, Research, Practice, Training, 43, 531–548. doi:10.1037/0033-3220.127.116.111
Huey, S. J., & Polo, A. J. (2008). Evidence-based psychosocial treatments for ethnic minority youth. Journal of Clinical Child and Adolescent Psychology, 37, 262–301. doi:10.1080/15374410701820174
Kirmayer, L. J., du Fort, G. G., Young, A., Weinfeld, M., & Lasry, J. C. (1996). Pathways and barriers to mental health care in an urban multicultural milieu: An epidemiological and ethnographic study. McGill University, Montreal: Culture and Mental Health Research Unit. Retrieved from: https://www.mcgill.ca/files/tcpsych/Report6.pdf
Melfi, C. A., Croghan, T. W., Hanna, M. P., & Robinson, R. L. (2000). Racial variation in antidepressant treatment in a Medicaid population. Journal of Clinical Psychiatry, 61, 16–21. doi:10.4088/JCP.v61n0105
Mok, H., Lao, D. W. L., Lin, D., Wong, M. P., & Ganesan, S. (2003). Chinese Canadians in a cross-cultural psychiatry outpatient clinic: Some exploratory findings. BC Medical Journal 45, 78–81. Retrieved from: http://www.bcmj.org/article/chinese-canadians-cross-cultural-psychiatry-outpatient-clinic-some-exploratory-findings
National Association of Social Workers (2001). NASW standards for cultural competence in the practice of social work. Washington, D.C.: NASW Press.
Safran, J. D., & Muran, J. C. (2006) Has the concept of the therapeutic alliance outlived its usefulness? Psychotherapy: Theory, Research, Practice, Training, 43, 286–291. doi:10.1037/0033-318.104.22.1686
Smith, T. B., Domenech Rodrıguez, M. M., & Bernal, G. (2011). Culture. Journal of Clinical Psychology, 67, 166–175. doi:10.1002/jclp.20757
Snowden, L., & Yamada, A. M. (2005). Cultural differences in access to care. Annual Review of Clinical Psychology, 1, 143–166. doi:10.1146/annurev.clinpsy.1.102803.143846
Stewart, S. L. (2008). Promoting Indigenous mental health: Cultural perspectives on healing from Native counsellors in Canada. International Journal of Health Promotion and Education, 46, 49–56. doi:10.1080/14635240.2008.10708129
U.S. Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicity—A supplement to mental health: A report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General. Retrieved from: http://www.ncbi.nlm.nih.gov/books/NBK44243/pdf/TOC.pdf
Wampold, B. E., Mondin, G. W., Moody, M., Stich, F., Benson, K., & Ahn, H-N. (1997). A meta-analysis of outcome studies comparing bona fide psychotherapies: Empirically, "all must have prizes". Psychological Bulletin, 122, 203–215.
Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health service in the United States. Archives of General Psychiatry, 62, 629–640.