Fidelity to core components is largely preserved in cultural adaptation, but core component addendums, delivery, and contextualization are substantially changed. The CTAF and its patterns represent a key step in advancement of a maturing cultural adaptation science. (PsycINFO Database Record
Over the past four decades, the mental health field has struggled to define cultural competency and its efficacy in psychotherapy. Recent cultural competency and treatment adaptation studies have pointed to predominant evidence that cultural competency yields positive experiences and outcomes in treatment. What remains largely unknown, however, is why cultural competency works. Existing literature provides guidance about knowledge, skills, and awareness for therapists to attain, and types and areas of psychotherapy to adapt to achieve cultural competency, but few have given a theoretical understanding explaining why these efforts would yield clinical improvement. In this paper, we present a thorough review of several decades of cultural competency and psychotherapy literature for the purpose of answering the question of how and why cultural competency works. Our literature analysis yielded 3 theoretical principles that explain the mechanisms of cultural competency. Cultural competency works because it creates: (a) a contextual match with clients' external realities; (b) an experiential match in the microsystem of the therapeutic relationship or framework; and (c) an intrapersonal feeling of being understood and empowered within the client. These theoretical principles unify a broad and variegated cultural competency and psychotherapy literature, and provide a common foundation for understanding the basic principles and mechanisms of culturally competent psychotherapy. A case example is provided to demonstrate clinical practice implications. The proposed theoretical model is preliminary with future research needed to empirically test these principles as mediating variables in the process of cultural competency in psychotherapy.
Findings advance the culture and suicide literature by highlighting how current research and practice that characterize suicidal ideation and behaviors as a mental health phenomenon may not comprehensively identify suicidality among an ethnic minority group.
Recent scholars have criticized the extant training and practice of suicide-risk assessment (SRA) as insufficient in terms of cultural competence (CC), arguing that advancements are needed in assessment tools and guidelines for training and practice in detecting suicide risk with diverse clients. These criticisms, however, have been based largely on conjecture. Data regarding barriers to or the extent of culturally competent suicide-risk-assessment (CCSRA) training and practice have been nonexistent. Aims of the current study were to assess the degree of training and practice in CCSRA among a random nationwide sample of 161 licensed doctoral-level psychologists. Results indicated that participants reported a bare minimum amount of training, lower diversity in, and fewer types of CCSRA training compared with general CC or SRA training. Even though psychologists in the current sample believed a patient's cultural background moderately to very much impacts level of suicide risk, they reported that cultural factors are only slightly to moderately incorporated in SRA practices. In addition, participants reported low comfort in employing CCSRA into practice. A mixed-methods approach identified 4 predominant barriers to practice, listed in order of importance: insufficient training, lack of knowledge and awareness, lack of experience with cultural minority clients, and a lack of practice guidelines. Participants who graduated after 2002 reported receiving more training and being more comfortable with general CC, but not CCSRA practice. Results suggest that standardized guidelines and training are necessary to advance doctoral training and practice in CCSRA.
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