A model for the theoretical basis of cultural competency to guide psychotherapy.

Abstract

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.

What are the barriers to, and facilitators of, implementing and receiving MHPSS programmes delivered to populations affected by humanitarian emergencies? A qualitative evidence synthesis

“…Another key theme was the importance of designing programmes that are socially and culturally meaningful to local populations to ensure they are appealing and achieve their intended aims. The importance of attending to cultural and ethical issues when supporting the mental health and psychosocial well-being of different groups is well documented (Chu et al 2016 ) and is one of the key challenges to the delivery of MHPSS programmes in diverse cultural settings in which emergencies often occur (Sommers-Flanagan, 2007 ; Wessells, 2009 ). To address this challenge, development of MHPSS programmes should consider exploring the needs of local communities by drawing on participatory approaches to facilitate stakeholder involvement in the design and delivery of programmes (Oliver et al 2008 ; Mockford et al 2011 ).…”

The Impact of Mental Health and Psychosocial Support Interventions on People Affected by Humanitarian Emergencies: A systematic review

“…The need to attend to cultural and ethical issues when addressing the mental health and psychosocial well-being of different groups of people is relatively well documented, 155 including for humanitarian settings. 156,157 The synthesized process evidence further reiterates this need.…”

Reducing mental health disparities by increasing the personal relevance of interventions.

“…Cultural competence involves: (a) awareness of one's own assumptions, values, and beliefs and how they can affect interactions with clients; (b) knowledge of clients' cultures and worldviews; and (c) skills in providing culturally-relevant treatment (D. Sue, Arredondo, & McDavis, 1992). A culturally competent therapist addresses contextual concerns beyond the individual, such as family, school, and work, as well as broader societal influences on the individual, such as discrimination, poverty, and poor access to resources (Chu, Leino, Pflum, & Sue, 2016). However, in a recent meta-analysis, patients' perceptions of therapist cultural competence were only mildly associated with symptom reduction (Smith & Trimble, 2016).…”