PSY 3310 Module 6 Multicultural Competence and Integrative Approaches Paper: Cultural Adaptation, Humility and Integrative Practice Example

Same Treatment, Different Lives: Culture, Humility and Integrative Therapy

Student Name

Bachelor of Arts in Psychology, Thomas Edison State University

PSY-3310: Clinical Interventions and Disorders

Mentor Name

Month Day, Year

Same Treatment, Different Lives: Culture, Humility and Integrative Therapy

Introduction

Paterson is one of the most diverse cities in New Jersey, with large Latino and Arab American communities. At our center, about half of new clients speak Spanish or Arabic at home, but only three of fourteen therapists speak either language. I have watched clients struggle to explain feelings through interpreters and heard some say the therapist "didn't get" their family's role in decisions. This paper asks what research says about culturally responsive therapy and how approaches from earlier modules can be integrated to serve diverse clients.

Multicultural Competencies

Sue et al. (1992) proposed a framework that became foundational in counseling. They described three characteristics of culturally skilled counselors: awareness of the values and biases their own upbringing gave them; grasp of the outlooks that clients from other backgrounds bring; and the ability to develop appropriate intervention strategies and techniques. Each characteristic has three dimensions: beliefs and attitudes, knowledge and skills. The authors argued that traditional counseling had often imposed white, middle-class values, such as individualism and verbal emotional expression, on clients for whom these did not fit, and that ethical practice required competence across cultures.

Does Cultural Adaptation Help?

Griner and Smith (2006) combined 76 studies testing treatments that had been modified to fit particular cultural groups, through changes such as matching language, incorporating cultural values, involving family or community and adjusting content. Culturally adapted interventions were moderately more effective than unadapted ones, averaging an effect a little under half a standard deviation. Interventions designed for a single cultural group produced roughly four times the benefit of those adapted for mixed groups, and programs conducted in a client's first language other than English had roughly double the effect of those conducted in English.

Cultural Humility

Competence can imply that a therapist has mastered a culture, which is impossible. Hook et al. (2013) developed a measure of cultural humility, an other-oriented stance in which the therapist is open to the client's cultural identity, curious rather than assuming and honest about how much they do not know. In studies of clients in therapy, clients who judged their therapists high in cultural humility described a better working bond and, in one study, greater improvement.

Integrative Approaches

Integrative therapy combines elements of different approaches to fit the client. Therapists may integrate theoretically, combining ideas from different theories; technically, drawing techniques from several approaches; or through common factors, emphasizing the relationship and shared elements. The approaches from earlier modules offer different strengths: CBT's structure, psychodynamic attention to relationships, humanistic empathy and existential focus on meaning. Cultural adaptation is itself a form of integration, fitting the treatment to the client's world.

A Composite Case

Consider Layla, a composite 28-year-old Arab American woman with anxiety, living with her parents and caring for younger siblings. A purely individualistic approach that encouraged her to "set boundaries" with her family might conflict with her values. An integrative, culturally responsive therapist might use CBT techniques for anxiety, delivered in Arabic if she prefers, while exploring with curiosity what family obligations mean to her, involving family if she wishes and drawing on her own sources of meaning, including faith, as existential approaches suggest.

Recommendations for the Center

Based on the evidence, I recommended that the center recruit bilingual therapists and support current staff in learning Spanish and Arabic; offer group programs adapted for specific communities in their languages; provide training in cultural humility, including structured reflection on therapists' own assumptions; and ask clients at intake about cultural identity, language preference and what they would like their therapist to understand about their background.

Working With Interpreters

When therapists and clients do not share a language, professional interpreters are far better than family members, who may filter what is said or face conflicts of loyalty. Therapists can plan with interpreters before sessions, speak directly to the client rather than to the interpreter and allow extra time. Still, Griner and Smith's findings suggest that therapy in the client's own language is better when it can be arranged.

Therapists' Own Awareness

The first of Sue and colleagues' competencies is awareness of one's own values. A therapist raised to see independence from parents as a sign of maturity may unknowingly treat a client's close family ties as a problem. Structured reflection, supervision and consultation with colleagues from the client's community help therapists notice these assumptions.

Stigma and Access

In some communities, seeking therapy carries stigma, and help may first be sought from family, clergy or primary care doctors. Partnering with community and religious organizations can help a center reach people who would not otherwise come.

Measuring Cultural Responsiveness

The center could ask clients a few questions after early sessions, adapted from cultural humility research, such as whether the therapist seemed open to learning about their background. Results would give therapists feedback and show whether training changes clients' experience.

Integration in Training

Training programs increasingly teach integration explicitly, showing students how to select techniques based on the client's goals and culture rather than loyalty to one school of therapy.

Limits

Studies of cultural adaptation vary in how adaptation was done, and many compare adapted treatment with no treatment rather than with the standard version. Cultural groups are internally diverse; adaptation must not become stereotyping. Layla is a composite.

Conclusion

Sue, Arredondo and McDavis defined the awareness, knowledge and skills culturally responsive practice requires, Griner and Smith showed that adapted treatments, especially in clients' own languages, are more effective and Hook and colleagues showed that clients value therapists who approach culture with humility. Integrating approaches flexibly, delivering care in clients' languages and approaching every client with curiosity can help a diverse city's counseling center fit treatment to the lives of the people it serves.

References

Griner, D., & Smith, T. B. (2006). Culturally adapted mental health intervention: A meta-analytic review. Psychotherapy: Theory, Research, Practice, Training, 43(4), 531-548. https://doi.org/10.1037/0033-3204.43.4.531

Hook, J. N., Davis, D. E., Owen, J., Worthington, E. L., & Utsey, S. O. (2013). Cultural humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology, 60(3), 353-366. https://doi.org/10.1037/a0032595

Sue, D. W., Arredondo, P., & McDavis, R. J. (1992). Multicultural counseling competencies and standards: A call to the profession. Journal of Counseling & Development, 70(4), 477-486. https://doi.org/10.1002/j.1556-6676.1992.tb01642.x