Soto, A., T. Smith, D. Griner, M. Domenech Rodríguez, and G. Bernal. “Cultural Adaptations and Therapist Multicultural Competence: Two Meta-Analytic Reviews.” Journal of Clinical Psychology 74 (2018): 1907–1923.
CENTRAL TAKEAWAY
Cultural adaptations of standard psychological treatments can enormously improve their efficacy, especially if the student population receiving treatment is culturally diverse.
SUMMARY
Scholars and practitioners have observed a growing interest in the use of culturally adapted psychotherapeutic interventions and in enhancing the multicultural competence of clinical staff. Here, therapists are considered to have culturally adapted an otherwise-standard mental health treatment when they modify the treatment goals, methods, language, metaphors, and so forth to more closely match the cultural patterns and values of the client that they are treating. Similarly, cultural competence is here defined as a clinician’s ability to effectively engage with clients from a range of different cultures, including an awareness of these cultures, knowledge regarding the content of the cultures, and the skills necessary to operate in said culture. While scientific interest in these concepts is robust, the degree to which they make a material difference in the mental health outcomes of clients has been difficult to determine.
The authors of these two meta-analyses sought to evaluate the efficacy of these practices in order to clarify their general effects as well as identify which forms are most effective and for whom. The first analysis examining culturally adapted interventions reviewed 99 experimental or quasi-experimental studies from the U.S. and Canada, and resulted in an aggregate sample size of nearly 14,000.
The second meta-analysis gathered a total of 15 studies regarding cultural competence as it related to treatment outcomes. Unlike the first meta-analysis, these publications included cross-sectional as well as longitudinal studies, and all studies used samples composed of at least 90% people of color.
DISCUSSION OF THE FINDINGS
Culturally adapting psychological treatments appears to be generally more effective at reducing mental illness than the same non-adapted treatments by about 0.35 standard deviations. That said, there are many different methods of cultural adaptation and some appear to be far more effective than others. Specifically, offering counseling services in the preferred language of patients was considerably more effective than only offering services in English. Furthermore, when co-developing clinical goals with patients, therapists should explicitly base these goals on the client’s cultural values. Finally, when engaging in treatment itself, therapists should strive to use metaphors, values, perspectives, and terms that are derived from the client’s culture.
All of these adaptations appear to be significantly more effective the older patients are, possibly because younger patients often have more multicultural experiences than their older peers. Regardless, this finding is especially important for those engaged in adult education, and for postsecondary institutions who serve older student populations.
The type of disorder being addressed seems to influence the efficacy of culturally adapted therapies compared to non-adapted therapies, with treatments focused on specific outcomes like managing depression and aggression having roughly half a standard deviation of increased effectiveness. On the other hand, while adapted treatments focused on improving general well-being or mental health were still more effective than non-adapted treatments, the advantage was only about one quarter of a standard deviation.
Regarding counselors’ multicultural competence, the evidence is unclear. When clients of color perceive that their therapists have a strong ability to work across cultures, their outcomes are considerably better; however, a portion of this is likely due to the ‘halo effect’ (i.e., a patient has positive experiences with their counselor and assumes that their skill in counseling also extends to skills in multiculturalism). Furthermore, counselors’ self-assessment of their multicultural skills had almost no relationship with their client outcomes, further calling these findings into question.
IMPLICATIONS FOR ACTION BY CAMPUS LEADERS
Training campus counselors to culturally adapt their therapies appears to be a worthwhile investment, especially if one’s student population is culturally diverse. To guide their decision making in this context, CIC leaders may want to consider regularly assessing the age and racial and cultural characteristics of students who use mental health services on their campus. Additionally, hiring and retaining counselors who have experience in a variety of cultures may also be of value.
Mental health leaders may wish to prioritize matching the languages and cultures of students and counselors where possible. For cultural adaptations to be most effective, they should first be implemented for treatments of specific disorders (like depression), and should consist of multiple adaptations (e.g., values, metaphors, and language) rather than one.
ABOUT THE AUTHORS
Alberto Soto is a research scholar in the Department of Clinical Psychology at Antioch University.
Timothy B. Smith is a professor in the Department of Counseling Psychology and Special Education at Brigham Young University.
Derek Griner is a clinical professor in the Department of Counseling and Psychological Services at Brigham Young University.
Melanie Domenech Rodríguez is a professor in the Department of Psychology at Utah State University.
Guillermo Bernal is the past president of the Caribbean Alliance of National Psychological Associations.
RECOMMENDED FOLLOW-UP LITERATURE
“Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality, 2017.” American Psychological Association. (2017) Retrieved from: http://www.apa.org/about/policy/multicultural‐guidelines.pdf
Domenech Rodríguez, M., and G. Bernal. Cultural Adaptations: Tools for Evidence‐Based Practice with Diverse Populations. Washington, DC: APA Press, 2012.
La Roche, M. J. Cultural Psychotherapy: Theory, Methods, and Practice. Thousand Oaks, CA: SAGE, 2012.