Service Utilization

As a result of such culture-specific representations of illness, service utilization may be impacted by how Latinos understand and attribute causes to mental illness. General lay theories of causation are guided by the holistic view of illness and are often attributed to supernatural causes, environmental causes (bad air), or strong emotions (embarrassment, envy, and others) (Molina & Aguirre-Molina, 1994). Because it is more socially appropriate for women or children to manifest illness...

Cultural Identity of the Individual

This would include (a) the client's cultural or ethnic preference groups, (b) in the case of immigrants, the degree of involvement with the culture of origin versus the host culture, and (c) language use and preference. For example, a Latino client might prefer the term Chicano rather than Mexican-American if he or she believes that the first term imply less degrees of acculturation to the Anglo-American Culture. An African American client might report more involvement with the Anglo-American...

Research Considerations In The Advancement Of Multicultural Psychotherapy

If the new multicultural worldview and approach to psychotherapy is to establish itself as the dominant paradigm for the new century, empirical research will be needed to validate the applicability and limitations of traditional and multicultural approaches to psychotherapy with culturally different peoples (Casas, 1995). Unfortunately, the current status of this research suggests that there is still much work to be done in evaluating the different therapy approaches (Atkinson & Lowe, 1995...

Ivacculturation Processes

It is important to have a better understanding of the mental health consequences of acculturation processes. Reaction of some form is not an uncommon response to culture contact. On some extreme positions, people become violent and attempt to extinguish or exterminate others' cultural systems or beliefs, including the people who support those systems. These reactions occur when people are threatened by some cultural feature of others. As the United States becomes increasingly more multicultural...

Culturally Competent Use of the Minnesota Multiphasic Personality Inventory2

Guadalupe X. ayala Counseling Psychology Program Joint Doctoral Program in Clinical Psychology University of Oklahoma San Diego State University-University of California, San Diego Norman, Oklahoma San Diego, California _ ,, _ SONIA MeNDOZA Behavioral Health Services California School of Professional Psychology Muscogee (Creek) Nation San Diego, California Okmulgee, Oklahoma Elahe Nezami Francisco C. Gomez, Jr. Institute for Health Promotion and Disease Prevention Research San Diego, California...

Asian Americans

The term Asian Pacific Islander Americans is used by the U.S. Census Bureau to denote over 51 groups of people. Among these, 30 are Asians and 21 are Pacific Islanders. The ten largest Asian groups are identified in the Census. They include, in descending order by size, Chinese, Filipino, Japanese, Indian, Korean, Vietnamese, Cambodian, Hmong, Laotian, and Thai. Twenty other smaller Asian groups are usually listed as other Asians, including an Asian-not specified category. The Pacific Islander...

Vague General Complaints

More important than determining the underlying, perhaps unconscious, reasons for seeking help, is the immediate task of discerning what is distressing the patient and converting that expression in the patient's own words, language, and concepts to the clinician's terminology and frame of reference. Many individuals from ethnic minority groups will express their distress in nonspecific terms I feel bad, I feel upset, I am nervous (nervios), and so on. It is thus important to attempt to have the...

Value Differences Impinging the Interview

At least in the United States, most immigrant groups come from less developed countries or rural small town communities where, what are called traditional values still have strong influence. These values are described as consisting of greater emphasis on family ties (as well as subservience of the individual to the will or benefit of the family or community), more strictly defined gender roles and beliefs in folk explanations for natural phenomena. (This is not an exhaustive list of the...

Where Do We Go From Here

Basic recommendations for future assessment and treatment of Latinos include the following five aspects (a) being informed by previous literature and cultural models, (b) acknowledging diversity within ethnic groups, (c) assessing the cultural being, (d) awareness of cultural values and culture-specific illness manifestation, (e) culturally tailored treatment as appropriate. In order for mental health service providers to become culturally aware it is important to understand the complex nature...

Guidelines To Distinguish Psychopathology From Culturerelated Conditions

Despite the above difficulties in establishing a distinction between psychopath-ological conditions unrelated to cultural variants and culturally related disorders, several guidelines exist in the literature to assist practitioners in making that distinction in clinical practice (Castillo, 1997 Paniagua, 1998 Tseng & Streltzer, 1997). Paniagua (1998) suggested four guidelines (a) consultation with family members, peers, and folk healers within the multicultural group (b) an examination of...

Natural History of Suicidal Behaviors

Epidemiological research on adolescent suicide historically has focused on etiology. That is, the research questions driving the inquiry concern identifying which factors under what circumstances increase the likelihood that youths will kill themselves. However, epidemiology is not just the study of the distribution and the causes of diseases. Epidemiology also focuses on the natural history of disease, including its consequences (Friis & Sellers, 1996 Sackett, Haynes, Guyatt, & Tugwell,...

Introduction

An accurate picture of demographics of any society is crucial to assess a variety of health and human needs and planning for the future. Demographic characteristics of a given population, community, or ethnic group provide meaningful indicators of need, risk, and type of service interventions required. For example, if a significant segment of a given population or community is composed of ethnic minorities, and it is known that special needs or risks are associated with that ethnic status, then...

Summary

Culture and ethnicity are powerful forces in our society, influencing the lives and the health of all individuals, including older adults. While it is clear that ethnicity, culture, and minority status are associated with very real differences in the rates of mental disorders among the elderly, it is also clear that these variations are the result of differences in socioeconomic status, gender, age, and social class, coupled with cultural differences. These factors can compound diagnostic...

Minority and Immigrant Status as Antecedents of Distress

The status of Asian Americans as members of a visible racial minority group in the United States is likely to influence the content of their distress. In an analysis of Asian American-White American differences on various indices of personality patterns (many of which are traits associated with distress), Uba (1994) proposed that the documented ethnic differences can be interpreted on the basis of cultural value differences and the status of Asian Americans as minorities. For example, Uba...

References

Ethnic identity The transformation of White America. New Haven, CT Yale University Press. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed. rev.), Washington, DC Author. Andrews, J. A., & Lewinsohn, P. M. (1992). Suicidal attempts among older adolescents Prevalence and co-occurrence with psychiatric disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 655-662. Aries, E., & r Moorehead,...

D

Delirium Rating Scale, 331 Delirium Symptom Interview, 331 Delusional Disorder, 146 dementia, 133, 330-331 prevalence rates of, 333 demographics African Americans, 87-90, 195-196 American Indians, 85-87 Asian Americans, 90-92 demographics (continued) ethnic minorities, 80-93 Hispanics, 82-85 United States, 455-457 Depersonalization Disorder, 147 depression, 7, 9,17, 22, 24, in adolescents, 360-366 in Asian Americans, 176 and minorities, see Ethnicity and depression in elderly, 334-335...

Specific Treatment Suggestions

Given the aforementioned lack of transportation as well as the distances between clinics and clients' homes, the first step in treatment with American Indians and Alaska Natives should be to identify where intervention should occur. In some instances, sessions will not occur or will occur inconsistently unless the clinician is willing and able to visit the client's home (Willis, Dobrec, & Bigfoot Sipes, 1992). In addition to transportation concerns, some individuals and families may be very...

B

Beck Depression Scale Inventory, 331, 361-362 behaviorism, 279 beliefs, 12, 16, 18 health, 28 as internal representations, 12 religious, 21 Bern Sex Role Inventory (BSRI), 64 berdache, 67 bias, 5, 9, 12, 18 in APA Ethics Code, 9 in assessment methodology, 116-117 construct, 131 cultural, 19 ethnocentric, 7 historical mistrust, 273 interpretation, 103-107 item, 102 linguistic, 102 metric, 102 in research, 97-103 in standardardized tests, 107-117 bicultural, 13 Bicultural Effectiveness Training,...

Info

Adapted from Holzer, Swanson, and Shea (1995). Hispanics. The corresponding rates for a 1-year prevalence period were 19 , 26 , and 20 , respectively. In both instances the rates are significantly higher for Black than for White respondents. More detailed analyses of lifetime and 6-month prevalence for Mexican Americans have been presented by the Los Angeles ECA group (Burnam et al., 1987 Karno et al., 1987). In subsequent ECA analyses, Holzer, Swanson, and Shea (1995) presented ethnic...

Culture And Meaning

Culture lies at the very heart of what it means to be human. Yet the study of culture has become an increasingly sophisticated undertaking that proceeds well outside of the language of everyday discourse, even as its objective is to understand everyday discourse. This situation results from the fact that understanding the role of culture in social and personal life requires that we somehow stand outside of it, and that we observe the social world from a privileged position unaffected by the...

How to Handle Religious Concerns

Many patient's religious beliefs and behavior may seem extreme or pathologic to the clinician. There was a time when modern psychologic thought considered almost all forms of religious expression a form of neurosis. Thankfully this time is past. However, now during a time of heightened spiritual yearning the issue assumes great relevance. Among some minority patients, rigidly held religious views are common and are not in and of themselves pathologic, although some fundamentalist Christian...

Summary And Conclusions

Femininity and masculinity are not innate, permanent, or universally defined. The particular cultural context in which racial ethnic minority groups live their daily lives gives unique meaning to conceptions of femininity and masculinity. Culture and gender work jointly to affect the attitudes, feelings, characteristics, and behaviors experienced by such groups. Knowledge and appreciation of such cultural definitions are as important to effective assessment and treatment of mental health issues...

Acculturation And Psychological Adjustment

Marsella and Kameoka (1989) describe a model that depicts the relations of culture to pathology. In their interactional model, the environment is divided into physical and cultural components that interact with person variables that are also divided into two components (a) physiological genetic component and (b) a sociocultural component (cf. Marsella, chapter 1, this volume). Culture plays a prominent role in this model as it represents both external and internal factors influencing our...

Avoidant and Dependent Personality Disorders

Variations exist in the degree to which different cultures and ethnic groups regard avoidance as appropriate. Symptoms of this disorder may also result from acculturation problems associated with immigration (DSM-IV, 1994, p. 663). The appropriateness of dependent behaviors varies across sociocultural groups. Behaviors associated with this disorder (e.g., passivity, difficulty in making everyday decisions) would be considered characteristic of this disorder only when they are clearly in excess...

Mexican Americans and Immigration

It is useful at this point to turn to a study by Vega et al. (1998), which addresses the prevalence of disorder in a Mexican American sample and relates that prevalence to immigration. This study used methods based on the CIDI, with a Spanish-language translation, to conduct a survey of Mexican Americans in Fresno County, California. They focused primarily on issues of migration, with the overall finding that rates of disorder were higher among the U.S.-born Mexican Americans than among those...

Perceived Therapist Credibility

As research questions and methodologies have become more sophisticated, researchers have shifted their attentions from client preference for ethnically and racially similar therapists to perceived therapist credibility (S. Sue, 1988). Atkinson and Lowe's (1995) review of the role of ethnicity in counseling, for example, found credibility in some instances to be more salient than ethnic or racial match. Recent research on perceived therapist credibility have confirmed its salience in the...

The Multicultural Psychotherapist As Social Engineer

The multicultural psychotherapist should aspire to be a social engineer or community leader in the movement toward an inclusive, culture-centered pluralistic society. But this view, according to Draguns (1989), is a delicate charge for the contemporary multicultural psychotherapist. As psychotherapists, our knowledge is far greater about changing people than changing societies (p. 15). We therefore must realistically and sensitively balance our responsibilities to help culturally different...

Religious or Spiritual Problems

The DSM-IV suggests that a client's religious and spiritual beliefs should be considered in those cases when such beliefs leads to distressing experiences that involve loss or questioning of faith, problems associated with conversion to a new faith, or questioning of spiritual values (DSM-IV, 1994, p. 685). Religious or spiritual problems may also be the focus of clinical attention in those cases when a clinician believes that such a problem interferes with the overall assessment and treatment...

Contributors

Numbers in parentheses indicate the pages on which the authors' contributions begin. RONALD J. ANGEL (25), Department of Sociology, University of Texas at Austin, Austin, Texas 78712 BILL R. ARNOLD (121), Department of Psychology and Anthropology, University of Texas Pan American, Edinburg, Texas 78539 GUADALUPE X. AYALA (389), Joint Doctoral Program in Clinical Psychology, San Diego State University-University of California, San Diego, San Diego, California 92102 SANDRA A. BLACK (325), Center...

Special Problems For Research And Clinical Care

Differences in both the standard and cultural factors result in considerable variation in the rates and manifestation of mental disorders across ethnocul-tural groups, and can present special problems both for research and clinical care. Foremost among these issues is the problem of collapsing different groups into one ethnic category. Puerto Ricans, Cuban Americans, Mexican Americans, and other groups with roots in Latin America are all classified as Hispanic Americans. Although they share a...

Clinical Equivalence

Clinical equivalence of measures across cultures is an important concept that needs to be more frequently addressed as instruments are developed for use with dichotomous clinical categories. Clinical equivalence is defined as the ability of the translated measure to accurately discriminate impaired and non-impaired individuals in a manner similar to, if not better than, the original instrument. Establishing clinical equivalence involves several data comparisons. First of all, the specificity,...

To What Extent Is The Mmpi2 Used With American Ethnic Minorities

Since 1989, when the MMPI-2 was published as the revision of the original MMPI (see Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989), 58 studies have been conducted with ethnic minority groups in the United States (including Puerto Rico). Table I presents studies on ethnic racial groups using the MMPI-2. The subgroup entitled multiple groups indicates that the studies included more than one ethnic group. Unlike research with the MMPI, which primarily focused on African Americans (see...

Symptom Presentation

Misidentification of causal sources may be more common in cross-cultural settings because of the recognized tendency among some groups to somatize their distress. This can be treacherous ground even for the medically trained clinician. Assuming that a somatic symptom is due to somatization of distress may be just as erroneous as the opposite focusing on a somatic symptom as though it had no emotional component and perhaps needlessly pursuing it diagnosti-cally. I recently saw a Mexican American...

Ecological Validity

Besides cultural adaptation and educational attainment, another important issue is that of biopsychosocial context now referred to as ecological validity. The question of validity moves us away from what variables affect brain function to how they affect brain dysfunction. In other words, we now begin to focus not on questions as to whether ethnic minorities are slower on neuropsychological tests nor if education mediates brain function. Ardila (1995) has stated that cultures dictate what is...

Bias In Standard Psychological Tests

This section reviews the present status of the MMPI MMPI-2. RCS, and TAT for cross-cultural and multicultural assessment with particular emphasis on reduction of bias in test construction, more adequate use of available normative data, some mechanics for increasing reliability of interpretations, and current research methodologies applicable to each test. This review separates the interim objective of this chapter bias reduction from the long-term issue of whether or not bias reduction per se...

Conclusion

In closing I want to remind the reader of my caveat at the beginning of this chapter that it is difficult, if not impossible, to learn sound clinical interviewing from a book. My own most valuable learning about interviewing occurred by observing seasoned clinicians conduct an interview and then discuss why they did what they did. I have tried to present a few basic principles that may be helpful in all cross-cultural settings, but there are many more valuable principles and techniques. In...

Discussion

As this review of studies shows, there are still relatively few data on prevalence of suicidal ideation, plans, or attempts in specific ethnocultural groups. Available results suggest minority status may increase the risk of suicidal behaviors, but also that the effects vary depending on the outcome examined (ideation vs. attempts vs. plans) and the group studied. For example, in one of our studies (Roberts, Chen, & Roberts, 1997), Mexican American, Pakistani American, Vietnamese American,...

Cultural Versus Psychological Determinism

The literature we have reviewed demonstrates that a growing number of researchers have come to the realization that individual behaviors are motivated by psychological factors that give meaning to actions within specific cultural and social contexts, yet those contexts are fluid and changing. Socialization is far more complex ihan Uauilioiial sociological theories held, and culture does not consist of a set of rigid norms that all members of a particular culture follow blindly. Cultural...

Minority Clients Race Or Ethnicity Is Necessarily Related To The Presenting Problem

In multicultural literature, it has been suggested that clinicians and counselors be cognizant of how being a racial or ethnic minority in the United States has influenced the psychosocial development of members of minority groups (e.g., Jackson, 1987). Some models of multicultural psychology share the assumption that Minority groups develop modal personality patterns in response to white racism (Helms, 1987, p. 241). Clinicians are expected to be aware of the sociopolitical forces that have...

A

Acculturating, 14, 48, 50 acculturation adjustment and, 10, 14-15, 45, 48-58, assessment of, 55, 75,104, 183, 259-262 levels of acculturation, 38, 186, 240-241 psychological acculturation, 46 psychological adjustment and, 54-55 stress, 14, 52-54, 211, 290 unidimensional model, 210 Acculturation Theory, 50 Acculturatative Stress Index (ASI), 396 Acculturation Rating Scale for Mexican Americans-II (ARSMA-II), 58, 217, 395, 396 adjustment disorders, 142-143,160 adolescents and suicidal behaviors,...

I

Identity, 6, 13-14, 17 idioms, 20 illiteracy concept of illness and disease, 17 manifestations of, 218 subjective aspects of, 26 Immersion Emersion Scale, 70, 291, 299 immigrants, 48, 210, 312, 328-329, 341-344, 400 Immigrant Paradigm of Acculturation, 48 Immigration and Nationality Act Amendments (1965), 92, 456 inappropriate care, 199 Index of Correction for Culture (ICC), 105, 108 Indian Health Service, 230 individualism, 8 Infant Mortality Rates (IMR), 84, 90, 93 inshallah, 14 Instrumental...

Interpretation Bias

Bias in interpretation occurs in both low-inference and high-inference tests, but in dissimilar ways with different potential remediations. Low-inference tests have formal scoring systems and normative data to use as a frame of reference for interpreting scores and derivative indices. The Rorschach, in RCS format, and the MMPI MMPI-2 are representative of low-inference tests. High-inference tests include the TAT and the pre-RCS Rorschach. The TAT has been used for many years in the United...

Acculturation And Clinical Manifestations Of Illness

Depression serves as an excellent example of an illness that is influenced by external factors such as contextual environment, culture, acculturation processes, and social psychological situations. Depression is also an illness definable by clinical DSM-IV criteria. As noted elsewhere in this handbook (see Panigua, chapter 8), culture shapes the manifestations of many illnesses, including those of depressive illness. It also determines the patient's explanatory model of their illness. As...

Use of Alternative Sources of Information

Family members (including extended family) and community members such as medicine men can be invaluable sources to consult (with a client's consent). As part of the culture and the client's daily life, these individuals possess a rich understanding of the client's social, emotional, physical, and spiritual functioning, both currently and across time. In addition, these individuals are perhaps most able to render culturally sensitive and accurate judgments as to the existence of pathology. For...

General Considerations

In approaching the subject of cultural proficiency training, it is important to bear in mind that the general ethnic racial labels used in the U.S. Census as well as in many textbooks typically include groups that share commonalities as well as diversities. The previous discussion is simply an illustration of the issues using the Asian American groups and the Hispanic American groups as examples. The same observations can be made of other ethnic cultural groups. For instance, in mental health...

R

Racial Identity Attitudes Scale (RIAS-B), 69 racism, 8, 10, 65, 69, 200, 206, 267, 290 Rational Emotive Therapy (RET), 188 refugees, 4, 9,16, religious beliefs, 262, 317, 320 experiences, 321 problem, 162 rituals, 16 resilience, 11, 93, 243 response styles, 365 response tendencies, 132 resources and supports, 14-15 Rey Auditory Verbal Learning Test, 422 Reynolds Adolescent Depression Scale (RADS), 362 Robert's UCLA Loneliness Scale-8, 58 Rorschach, 239 Rorschach Comprehensive System (RCS),...

Who Are The Minority Elderly

Older adults constitute the fastest growing portion of the population, as well as the most heterogeneous. By 2000, over 35 million Americans will be aged 65 or older, comprising 13 of the total U.S. population. The numbers of older adults are projected to exceed 53 million by the year 2020 and over 80 million by the year 2050, constituting over 20 of the entire population (U.S. Bureau of the Census, 1997). The largest contributing factors to the increasing numbers and diversity of older adults...

Practice Knowledge And Practice Skills

In this handbook a loose definition of cross-culture is employed a cross-cultural setting is one in which a provider and a consumer of mental health services are from two differrent ethnocultural groups. There are providers who deliver cross-cultural services who are not formally trained, via research-based knowledge, but nonetheless have practice experience. As aptly stated by Cer-vando Martinez in Chapter 15, One does not learn to conduct a good interview solely by reading about it. Most...

Treatment

In this final section, three topics in treating Asian American clients are highlighted (a) techniques for establishing credibility, (b) importance of maintaining flexibility with respect to the parameters of treatment as well as therapeutic approaches, and (c) availability of case studies that illustrate how to translate broad cultural concepts into cultural formulations of individual cases. These are necessarily broad descriptions that only introduce the reader to potential cultural issues in...

Diagnosis And Feedback

During the course of the clinical interview the clinician strives to elicit, observe, and note the patient's psychopathology and personal customs while simultaneously placing these in a social and cultural context determined by the person's background and development. The elaboration of psychopathology is affected by social and cultural factors, as is the expression of personal concerns. Individual defenses and personality development of course also intervene. Thus, one is commonly left...

Training in Cultural Competence

21 Limitations of the Multicultural Approach to Psychotherapy with Diverse Clients I. Minority Clients' Race or Ethnicity Is Necessarily Related to II. Non-White Cultures Arc Infallible 441 III. Race and Ethnicity Are Stronger Predictors of Behavior Than IV. In a Multicultural Therapy Situation. Therapists Arc White and Clients are Non-White Minorities 444 V. Racism and Prejudice Are Unique Characteristics VI. Psychology Is Irrelevant to Minorities'' 447 22 Responding to the Challenge Preparing...

The Employment Of An Ecological Perspective

To truly appreciate the importance and complexity of culture throughout the life span, it is necessary to employ an ecological perspective that examines behavior within the web of life. The most personal and private thoughts of each individual as well as outwardly expressed behaviors are products of the interaction of genetic and environmental forces. Cultural factors are a significant part of environmental forces, and cultural factors are a significant component of family, community values,...

Hispanics

There are several large groups of Hispanics in the United States, including those with different historical experiences regarding immigration. Historically, Hispanics and particularly Mexican Americans have been underrepresented in inpatient and outpatient populations (Roberts, 1981), a trend that has persisted through the last decade (Swanson, Holzer, & Ganju, 1993). Population-based studies of psychological symptoms have provided a mixed picture. Quesada, Spears, and Ramos (1978) showed...

Guidelines Of The International Test Commission

The four domains described by the International Test Commission include (a) Context (b) Development (c) Administration and (d) Documentation Score Interpretation (International Test Commission, 1993, as reported in Van de Vijver & Hambleton, 1996). Context-domain variables are defined as utilizing test translation methods that minimize or avoid construct bias, method bias, and item bias. Development of a cross-cultural instrument requires an in-depth understanding and knowledge of both the...

Learning From The Past

There is much to be learned from the evolution of the history of mental health research on Latinos and the emergence of more comprehensive models of culture. Originally, culture was a topic of consideration only for immigrants and was discussed in terms of their assimilation to the new society Early psychological approaches to culture were based on the dominant majority model, which reflected the assumption of the U.S. American melting pot. In the sense that individuals were expected to...

In A Multicultural Therapy Situation Therapists Are White And Clients Are Nonwhite Minorities

Currently, there is a plethora of articles and books written on multicultural psychology and many are written within a framework in which therapists (or therapists in training) are assumed to be White and clients are assumed to be non-White (e.g., Arroyo, 1996 Casas, 1987 Corvin & Wiggins, 1989 Helms, 1987 Ponterotto & Pedersen, 1993 Sue, 1993). Although it is accurate that the majority of therapists and graduate students in clinical and counseling programs are White, there is usually a...

Key Terms And Definitions

Several important terms to consider in any discussion about culture include gender, sex, femininity masculinity, and gender role. It is important to point out that one's gender is independent of one's sex. Gender refers to characteristics and behaviors considered appropriate for and typical of females and males by a particular culture (Unger, 1979). As such, gender is considered a social construction (Rothenberg, 1998), whereas, sex refers to one's status as a female or male, based on...

Dissociative Fugue

The sudden and unexpected travel away from home and work and the individual's inability to recall past events associated with this travel is a condition commonly reported among people from the Arctic, Subarctic Skimo, the Mis-kito Indians of Honduras and Nicaragua, and the Navajo Indians (Castillo, 1997 DSM-IV, 1994, p. 842). Some culture-bound syndromes named in Table I may have symptoms resembling this disorder. For example, pibloktoq is an episode involving an uncontrollable desire to leave...

Final Thought

Despite the importance of considering cultural variables in clinical practices, too much emphasis on these variables may prevent practitioners from considering symptoms as indicative of a severe psychiatric disorders. This emphasis could not only lead to misdiagnosis of real psychiatric disorders but it may also result in turning clients over to folk healers for treatment under the assumption that what the client is experiencing is a set of culturally related symptoms resembling a given DSM-1V...

Mental Health Needs

With respect to mental health, there is a very large and substantial body of research documenting the high rates of utilization of mental health facilities by African Americans, particularly inpatient psychiatric services (Cuellar, 1977 Manderscheid & Sonnenschein, 1987 Scheffler & Miller, 1989 Snowden & Cheung, 1990 Stolp & Warner, 1987). Admissions to state hospitals, general hospitals with psychiatric units, and community mental health centers by African Americans during the...

Difficulties In Distinguishing Psychopathology From Culturerelated Conditions

In clinical practice, the distinction between psychopathological conditions and culture-related situations might be difficult to apply for three reasons (Paniagua, 1998). First, managed care companies, Medicaid, and Medicare are demanding a significant reduction in the number of sessions with clients seeking mental health services, and the overall expectancy is that the first session (approximately 45 minutes to one hour) would be devoted to the assessment of the case and diagnosis of symptoms,...

Thematic Apperception Test

TAT use with multicultural populations in the United States relies on high-inference interpretation in a context of limited training to increase reliability of interpretation or the availability of culture-specific practice guidelines as suggested earlier in this chapter. There is also an ongoing debate concerning the continued utility of the original Murray cards as opposed to the adoption of new culture-specific sets of cards represented by the Tell-Me-A-Story Test for Latino African...

Four Multicultural Approaches

The majority of contemporary multicultural models (see Table I) can be categorized into one of four approaches culture-matching, acculturation adaptation, racial identity, and person-environment that are consistent with the six propositions and respective corollaries of MCT metatheory. The four approaches, however, are not mutually exclusive of each other. They instead emphasize different aspects of multicultural psychotherapy. In this regard, they carefully balance the universal and...

Future Research Directions

If multicultural psychotherapy is to be the fourth force in psychology, clearly more empirical research on process and outcome will need to be standardized and repeatedly replicated. Multicultural psychotherapy research must follow the benchmark that was set forth over 30 years ago when Paul (1967) and Kiesler (1966) both articulated the need to study the effectiveness of psychotherapy in terms of what types of treatments work best for particular types of clients across different settings. It...

American Indians

American Indian women are creating ways to address the gender-role conflict resulting, in large part, from the imposition of a restrictive, rigid system of gender relations introduced by the Europeans. One such strategy is retradi-tionalization or the extension of traditional care-taking and cultural transmission roles to include activities vital to the continuity of Indian communities (LaFromboise et al., 1990, p. 469). Retraditionalization is an effort by Indian women to combine traditional...

H

Halstead-Reitan, 132, 428 Hamilton Anxiety Rating Scale, 331 Hamilton Depression Rating Scale, 331 Handbook of Asian American Psychology, 172 Hawaiians, 462 health, 4-5, 8-10,12,17-18, 20-23 health care, 21 healthy paranoia, 267 high-inference test interpretation, 107,114, 117 Hispanic Americans, see also Latinos growth characteristics, 82 health risks, 84-85 Infant Mortality Rates (IMR), 83 residents, 82 subgroups of, 82 total fertility rate, 83 Hispanic Established Populations for the...

Impact of Historical Factors

Given this distant as well as recent history, it is not surprising many American Indians and Alaska Natives are distrustful of others. History has taught Indians and Natives that others may act in ways that threaten their physical safety or the survival of their culture. The impact of this historical backdrop on therapy is aptly described by Lockhart (1981) For an Indian person to entrust himself to an Anglo counselor, or to someone . . . representative of the dominant society, may be extremely...

Establishing Credibility

I have already discussed the supreme importance of establishing and maintaining credibility of mental health treatment with Asian American clients, especially if the clinician determines that the particular client is relatively less acculturated to Western world view. How does a clinician go about establishing credibility E. Lee (1997) argues that beyond the basics, such as air of confidence, empathic understanding, maturity, and professional mannerisms, there are a number of ways that a...

Reliability And Validity Of Translated Tests

A translated test should always provide information on the reliability and validity of the translation (Geisinger, 1992). Establishing the reliability and the validity of a translated test follows the same statistical format as that provided for any psychological instrument. Reliability statistics aimed at determining the internal consistency of the translated instrument must be included. Internal consistency coefficients should approximate those observed in the test construction of the...

Technical Equivalence

Test-taking behaviors have been hypothesized as culturally learned, providing an inherent disadvantage to those from ethnic backgrounds different from the test source (Geisinger, 1992). Lack of technical equivalence results in method bias. Variations in data collection or test administration procedures can prove to be critical in cross-cultural comparisons of the performance of translated measures. Adapted test administration procedures can produce variability in performance on translated tests...

Conclusions

Demographic growth characteristics are dynamically interrelated to fertility, mortality, and migration. Each racial and ethnic minority group in the United States has its own history of immigration and specific pattern of growth demonstrated in U.S. census data. There has been an ebb and flow of immigrants into the United States from the four major American minority groups. Each racial and ethnic group is composed of subgroups with each having their own pattern of growth. In general, all four...

Implications Of Genderrole Conflict For Assessment And Treatment Of Mental Health And Adjustment Issues

Because African American culture places considerable emphasis on the caretak-ing role for its women, therapists should move beyond a Eurocentric model of therapy and consider bringing siblings into the therapy session (Watson, 1998). Siblings who have been caretakers often have more influence on the personality development of younger siblings than parents do. In addition, dynamics of relating to siblings are often carried over into adult relationships. Exploring past sibling relationships could...

Immigration

One of the recurrent themes in the examination of ethnic groups is that of immigration. The most visible ethnic group is frequently the last to arrive. In his seminal volume, Emigration and Insanity, Odegaard (1932) describes the history of concerns with regard to mental health and immigration. From the earliest days of the American colonies, concern was expressed to keep out persons who were infirm and thus could become a public burden. In the late 1800s it was documented that along with...

Lifelong Professional Development

Cultural proficiency is a goal for lifelong professional development. Mental health professionals should continuously refine and develop their multicultural skills in order to maintain their relevance in the field. In this regard, in-service training and professional development workshops are crucial activities. The cultural competence continuum (Cross et al., 1989) and the cultural competence domains (Arredondo et al., 1996 Sue et al., 1992) are both very useful frameworks for workshop faculty...

Between the individual and the clinician

Included here are (a) ethnic and racial differences between the client and the clinician, and (b) the negative impact of these differences on the diagnosis and treatment of the client. For example, the fact that the client and the clinician are Hispanics does not necessarily mean that they share the same ethnicity (i.e., values, norms, and lifestyle). In this context, a Hispanic clinician, for example, who does not believe in the cultural values of machismo and marianismo would diagnosis a...

Ethnic and Racial Identity

For culturally different people who are ethnic and racial minorities in this country, the experience of racism and discrimination has a powerful impact on identity development. These experiences remind people of color that many individuals and institutions in society view them as perpetually different and oftentimes inferior. Over time, the experiences become incorporated into one's perceptions about oneself in the form of ethnic and racial identities. Ethnic and racial identities specifically...

Prognosis And Treatment A Closing the Interview

During the course of the interview as the clinician has tried to discern what ails the patient, what life concerns are most preoccupying, and what diagnoses best fit, he or she is also trying to get an idea of how the patient puts together the various elements of the history to explain what is being felt and experienced. This latter process has been called determining the patient's explanatory model of illness. It is important not only for the clinician to make this determination in his or her...

Schizoid and Schizotypal Personality Disorders

Defensive behaviors, detachment from social activities, and restricted range of emotions displayed by individuals from different cultural backgrounds may be erroneously considered as schizoid. For example, individuals who have moved from rural to metropolitan areas may show emotional freezing as manifested by solitary activities and constricted affect. Immigrants may also be mistakenly perceived as cold, hostile, and indifferent (DSM-IV, 1994, p. 639). In his cross-cultural interpretation of...

Body Dysmorphic Disorder

Preoccupation with an imagined physical deformity may be determined by cultural concerns about physical appearance and the importance of physical self-presentation (DSM-IV, 1994, p. 467 Castillo, 1997). For example, among some Hispanics thinner is associated with being sick, whereas hefty is perceived as healthy. Among many Anglo-Americans, the opposite is the accepted belief. In this context, a Hispanic client confronting these two conflictive beliefs in the North America culture would be very...

History

Although American Indians of the lower 48 United States and Alaska Natives are separated by at least a thousand miles, these groups share a set of common historical experiences. Both have suffered decimation of their people, loss of ancestral lands, and destruction of language, culture, and religion at the hands of U.S. citizens or others visiting or settling their land (Norton & Manson, 1996). It is estimated the American Indian population before European contact numbered approximately 9...

Concluding Remarks

This review of the use of the MMPI-2 with ethnic minorities, as well as presentation of the case studies, illustrates that progress is being made toward culturally competent assessment of ethnic minorities. In order to continue such progress, researchers and clinicians alike are encouraged to reexamine their standards of practice when using and interpreting standardized measures with ethnic minorities. An understanding of within- and between-group differences is necessary to provide a frame of...

Psychology Is Irrelevant To Minorities

Some social scientists interested in multicultural issues assert that, because much of psychology's notions about human behavior were developed based on the behavior of White Americans and Europeans, psychology's principles are irrelevant and nonapplicable to non-White minorities (Bell, 1971 Graham, 1992 Gunnings, 1971 Guthrie, 1976 Hall, 1997 Katz, 1985 Mitchell, 1971 Sue & Sue, 1990). More specific to therapy, Minority intellectuals have criticized contemporary counseling approaches which...

Trend

Researchers continue to compare ethnic minority groups to majority or White counterparts on the MMPI-2 (see Table I). This trend has carried over from research with the original MMPI. The primary aim of these types of studies is to answer the following questions Are there differences between an ethnic group, such as American Indians, and Whites on the MMPI-2 scales Or, does culture somehow differentially impact the performance of minorities and Whites on the MMPI-2 The prototypic study involves...

Assessment and Treatment Issues Common to All Racial and Ethnic Minority Groups

When acculturation pressures are part of the problem, the therapist would do well to make the client aware that adjustment to U.S. culture is not a matter of choosing between the culture of origin and the majority culture the individual can retain the former while mastering the latter. In other words, cultural incorporation is a viable option. Ethnic identity issues can be addressed similarly. In addition, a practitioner can administer acculturation and ethnic identity instruments to the client...

Native Americans

Community data on the mental health of Native Americans is sparse, but several types of statistics provide some cause for concern. High rates of suicide have been reported for Native Americans, particularly those who live on reservations. Manson, Beals, Disk, and Duclos (1989) reported that 23 of students in an Indian boarding school had attempted suicide and that 33 reported suicidal ideation in the past month. Similarly, high rates of alcoholism are reported in national arrest statistics for...

N

National Center for Health Statistics, 367 National Comorbidity Survey (NCS), 57, 175, 197, 347-350, 352-353 National Institute of Mental Health (NIMH), 346 Native American Indians adolescents, 211 suicidal behavior, 369 alcohol use, 240, 353 Alaska native, 225-245 Alaska Native Claims Settlement Act, 227 Aleutian, 329 confidentiality, 273-274 cultural values, 234-235 death rates, 230 demographics, 85-87 Eskimo, 456 fear of and hostility toward, 85 fluidity of identity, 86 full blood, 229 ghost...

Ethnicity As An Etiologic Agent

From an epidemiologic perspective, depression and suicidal behaviors can be viewed as the product of the same general factors believed to be involved in the etiology of both psychiatric and somatic disorders (see Cohen, Kessler, & Gordon, 1995 Dohrenwend, 1998). In general, disease outcomes are believed to result from the interaction over time of three etiologic forces biological, psychological, and social-environmental. Employing this framework, both depression and suicidal behaviors can be...

Reducing Bias in High Inference Interpretation

High-inference interpretation, often but not exclusively from a psychoanalytic perspective, was practiced prior to the 1974 RCS introduction by John Exner. High-inference interpretation practice was responsible for diminished usage of projective methods. Skepticism increased with regard to the psychometric credibility of these methods as tests were coupled with an increasing preference for objective tests in the United States. Nonetheless, high-inference interpretation is both theory-driven and...

Issues Likely To Influence Rates Used In Ethnic Comparisons

In closing this chapter it is useful to review some of the issues that make comparisons among ethnic groups difficult at best and otherwise quite misleading. The first of these is the specification of the ethnic group or population being studied. For the most part ethnic groups are inadequately identified by broad categories. Subgroups within broad categories are likely to differ in cultural as well as social and economic circumstances. One of these elements is their historical experience with...

Bipolar I and II Dysthymic and Cyclothymic Disorders

Differential incidence of Bipolar Disorder I associated with race or ethnicity has not been reported (DSM-IV, 1994, p. 352). Some evidence exists suggesting that clinicians may overdiagnose Schizophrenia rather than Bipolar Disorder I in some ethnic groups (DSM-IV, 1994, pp. 352-353). The DSM-IV (1994) did not provide a description of cultural variants for Bipolar II, Dysthymic, and Cyclothymic Disorders. A major characteristic of Bipolar II and Cyclothymic Disorders is the presence of...

Case 1 Sandra

Sandra is a 24-year-old female college student who was born and raised in Mexico until the age of 13, when her family moved to the United States. Sandra entered therapy in English, but quickly switched to Spanish because she felt more comfortable self-disclosing in her native language. Her therapist identified herself as Mexican American and Spanish-speaking. In total, she was administered the MMPI-2 three times. At intake she was administered the MMPI-2 in English. She obtained a valid profile...

Ecological Interventions In Mental Health

The problems frequently associated with minority status and acculturation are numerous. Among some of the characteristics of minorities include, for exam- pie, low educational status, high unemployment, high rates of poverty, high risk for some health and mental health problems, high risk for victimization, high rates of incarceration, and high risk for engaging in violence. Psychology as a profession, according to Shore (1998), is still establishing its identity and more recently has been...

Clinical Vignette

A 62-year-old married woman who was born in Mexico as on previous occasions became tearful as she described a recent interaction with a married daughter who was going through a divorce. She spoke in English, although it is clearly not her best language, as she described a series of interactions where she invariably ended up being hurt or rejected, made to feel unloved, adding to her chronic sadness, bitterness, and unforgiving nature. I had heard her speak this way before many times, and...

Personality Disorders A Paranoid Personality Disorder

Behaviors influenced by sociocultural contexts or specific life circumstances may be erroneously labeled paranoid. For example, immigrants, political and economic refugees, and members of minority groups may show guarded or defensive behaviors because of either unfamiliarity with the language, rules and regulations in the United States, or because of the perceived neglect or indifference of the majority society (DSM-IV 1994, p. 636). Castillo (1997) provided further illustration of this...

Reducing Bias in Low Inference Interpretation

Low-inference interpretation relies on norms for the relative meaning of test scores obtained for a particular assessee. Norms provide a rationale for the words and sentences contained either in a personality portrait or in a description of the symptomatology required for a diagnosis of psychopathology. This practice assumes that the norms used for these purposes are representative of the population being assessed and consequently adequate for particular assesses. The history in the United...

Maintaining Flexibility

There is a general agreement that the clinician should maintain flexibility with respect to the traditional rules of Western psychotherapy when treating Asian American individuals and families. For instance, not accepting small gifts from clients may be perceived as rude by some Asian Americans. In working with Asian American elderly clients, Kao and Lam (1997) suggest that clinicians practice mental reservation, which involves deferring the detailed explanation of some Western psychotherapy...

Overview Theory Models and Demographics

1 Culture and Mental Health An Introduction and Overview of Foundations, Concepts, and Issues Anthony J. Marsella ami Ann Marie Yanuula A. Overview of Foundations 3 B. The New* Culture and Mental Health 5 C. The Neo-Kraepelinian Movement 6 E. Individualism and Scientlsm 8 F. American Psychological Association Guidelines 9 G. The Maturation of the Field 9 II. Overview of Culture and Mental Health Questions, Concepts, A. Some Defining Questions 11 B. Some Important Concepts 12 C. Cultures as...

T

Tell Me A Story (TEMAS), 114 Test-retest, measures of reliability, 130-131 Texas-Mexico Border Health Coordination Thematic Apperception Test (TAT), 98, 102, 107,114 Total Fertility Rate (TFR), 83,86, 91 traditionals as acculturative type, 51 transactional, 45 transcendent orientation, 296 transcultural, 45, 47, 50 Transcultural Counseling, 288 transference themes in Asian Americans, 179-180 Transference and Empathy in Asian American Psychotherapy, 172 translation, 102, 108, 114, 121-134, 265,...

Iiculture Defined

Culture has been defined in over one hundred ways. The definition used by Anthony Marsella (chapter 1, this volume) is the definition that will be used here as well. It defines culture as shared learned meanings and behaviors that are transmitted from within a social activity context for purposes of promoting individual societal adjustment, growth, and development. Of much importance in Marsella's definition is the idea that culture is directly related to adjustment, growth, and development....

Between Group Variation

These within-group differences can present problems in sampling minority elderly for research. Research into the mental health and mental health needs of diverse elders is a relatively new phenomena African Americans began being systematically studied in the 1950s, Hispanic Americans in the 1970s and 1980s, Asian Americans and Native American studies began even more recently (Markides, 1986). Furthermore, large-scale studies that have included minority elderly, such as the Duke and Hispanic...