Addressing Cultural and Ethnic Minority Issues: The Pitfalls

Evidence has shown that our current forms of mental health treatment have been especially inadequate for ethnic minority populations, and finding interventions that are culturally competent has been an enduring significant challenge in the psychotherapy community. Nearly four decades ago, S. Sue and McKinney (1975) found that ethnic minorities tended to underutilize mental health services, compared to white individuals. Although different efforts have been made to improve mental health services for ethnic minority clients, recent reports continue to document that mental health services were often inaccessible, inappropriate, or poorly delivered (U.S. Department of Health and Human Services [DHHS], 2001, 2012).

Some recent studies reveal that utilization and treatment outcomes for ethnic minority groups are enhanced by the provision of culturally competent services (Griner & Smith, 2006; Smith, Domenech Rodríguez, & Bernal, 2011). Cultural competency has been categorized into three basic characteristics of mental health providers, namely:

1. Cultural awareness and beliefs. A culturally competent counselor or provider is sensitive to her/his personal values and biases and how these may affect perceptions of the client, the client’s problem, and the counseling relationship.

2. Cultural knowledge. The counselor has knowledge of the client’s culture and expectations for the counseling relationship.

3. Cultural skills. The counselor is able to intervene in a manner that is culturally appropriate and relevant. (D. W. Sue, Arredondo, & McDavis, 1992; D. W. Sue et al., 1982).

In his edited volume, Mindfulness and Acceptance in Multicultural Competency, editor Akihiko Masuda, PhD, asserts that the acceptance and mindfulness models may provide a promising method for promoting cultural competency and addressing social issues. To enhance the potential fruits that emerge from acceptance and mindfulness models, Masuda suggests that common pitfalls associated with research and practice in psychology in general and mental health in particular must be addressed.

Research on acceptance- and mindfulness-based treatments is still in a relatively early stage of development, and the available knowl­edge on their effectiveness in ethnic minority clients is especially sparse. For example, if we are interested in identifying what mental health treatment works for whom and under what conditions, very little empirical research is available to address this issue (DHHS, 2001).

Fuchs, Lee, Roemer, and Orsillo (2013) conducted a meta-analysis of acceptance- and mindfulness-based treatments with clients who are not traditionally the focus of psychological treatment outcome studies (e.g., non-White individuals, older adults, and individuals whose first languages were not that of the majority group). Reviews of the yielded 32 studies that met the inclusion criteria suggested that although some progress has been made in the inclusion of ethnic minorities, ethnic minorities are still underrepresented in most clinical trials.

Problems occur when theories are assumed to be universally true when their validity is confined to one culture or population. Unfortunately, a nasty thing happened on our way to our universal generalizations: culture and context turned out to have a much more fundamental effect on our generalizations than we expected.

Is it possible that in some cultural groups, psychological denial and avoidance are healthy? Conversely, might some cultural groups find acceptance and mindfulness principles especially congruent with their cultural beliefs and practices? Obviously, much more research is needed to identify the effectiveness, underlying processes, and generality of findings associated with acceptance- and mindfulness-based therapies.

References

Fuchs, C., Lee, J.K., Roemer, L., & Orsillo, S.M. (2013). Using mindfulness- and acceptance based treatments with clients from nondominant cultural and/or marginalized backgrounds: Clinical considerations, meta-analysis findings, and introduction to the special series: Clinical considerations in using acceptance- and mindfulness-based treatments with diverse populations. Cognitive and Behavioral Practice, 20(1), 1-12. doi: 10.1016/j.cbpra.2011.12.004

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

Smith, T., Domenech Rodríguez, M. M., & Bernal, G. (2011). Culture. Journal of Clinical Psychology, 67, 166–175. doi: 10.1002/jclp.20757.

Sue, D. W., Bernier, J. B., Duran, M., Feinberg, L., Pedersen, P., Smith, E. et al. (1982). Position paper: Cross-cultural counseling competencies. The Counseling Psychologist, 10, 45–52.

Sue, D. W., Arredondo, P., & McDavis, R. (1992). Multicultural counseling compe­tencies and standards: A call to the profession. Journal of Counseling and Development, 70, 477–486.

Sue, S., & McKinney, H. (1975). Asian Americans in the community mental health care system. Journal of Orthopsychiatry, 45, 111–118. doi: 10.1111/j.1939-0025.1975.tb01172.x.

U.S. Department of Health and Human Services (DHHS). (2001). Mental health: Culture, race, and ethnicity. A Supplement to Mental Health: A Report of the Surgeon General. Retrieved from http://www.surgeongeneral.gov/library/mentalhealth/cre.

U.S. Department of Health and Human Services (DHHS), Agency for Healthcare Research and Quality. (2012). National healthcare disparities report: 2011 (AHRQ Publication No. 11-0006). Retrieved from http://www.ahrq.gov/research/findings/nhqrdr/nhdr11/nhdr11.pdf.