Preface

During the last half of the 20th century, researchers placed a great deal of importance on brain-behavior relations. Much knowledge and control were undeniably gained from such efforts, but unfortunately culture, the true roots of much of our behavior, was largely overlooked. This general disregard of cultural factors not only led to false generalizations but blocked understanding of the real forces that motivate and shape our perceptions, attitudes, and actions (Horney, 1937). The aspiration of the editors and contributors of this handbook is to right this wrong and to lay the foundations for a more balanced perspective in the coming century.

What clinicians or students of mental health must know about delivering mental health services to diverse populations is complex and multifaceted, but the essentials are within their grasp. The clinician trained to be competent with persons from different cultures must integrate formalized research-based knowledge about a given cultural group with experiential and practice-based knowledge about that specific cultural group. This handbook follows the same principle; the reader's challenge is to learn as much relevant scientific knowledge as possible and to integrate that knowledge with experiential, practice-based knowledge. The contributors to this handbook have provided multiple methods for depicting and integrating research knowledge with experiential knowledge. Learning relevant skills is a continuous process, and cultural competence, likewise, is an ongoing process—not a state to be achieved. As our knowledge of a domain grows, this knowledge must be integrated with what was previously known. Unfortunately, this process often entails unlearning what was previously learned. This is particularly true when we are learning about diverse groups, as too often our knowledge about a group, even our own group, is based on erroneous and stereotypic information gained from childhood experiences. It is important to have an open mind when we approach something new and different.

The handbook is divided into four parts. Part I provides a foundation of history, theory, and concepts. Models and schemas for understanding the role of culture with respect to illness and behavior are included. Part II addresses methodological concerns vital to understanding and interpretating data obtained in cross-cultural clinical practice regardless of whether etic or emic measures were used in assessment processes. Part III provides essential content knowledge and research-based clinical knowledge, including unique etiological factors, prevalence data, symptom patterns and manifestations, cultural illness ideologies, and treatment considerations for each of the four racially or ethnically diverse populations. Additionally, Part III contains several chapters addressing the effects of ethnocultural factors on the assessment and treatment of adolescents, adults, elderly, and HIV/AIDS groups. Several chapters in Part III also focus on how to conduct the cross-cultural interview, how to interpret the Minnesota Multiphasic Personality Inventory, 2nd ed. (MMPI-2), how to conduct cross-cultural neuropsychological assessments, and how to identify cultural influences on Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) diagnostic categories. Part III includes an important chapter on the essentials of multicultural psychotherapy along with its current status and future prospects. Part IV addresses training concerns with respect to multicul-turalism, undoubtedly a potent force in the behavioral sciences.

In addition to the above explicit knowledge in multicultural assessment and treatment, some fundamental concepts are implicit in this handbook. One important implicit concept is the concept of cultural competence: What is it and how is it achieved? In these challenging times for practitioners of health and human services, cultural competence is a means of defending, protecting, and enhancing professional mental health care practice. Some of the essentials of cultural competence addressed in this handbook are briefly reviewed here:

1. The employment of an ecological perspective

2. An understanding of the relations of culture and mental health

3. Mastery of knowledge in content areas: knowing about various cultures

4. Practice knowledge and experiential skills

5. Integration of practice knowledge and practice skills

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