Cultural concealment and therapy outcomes.

Abstract

Therapy is predicated on the need for clients to share intimate details about their lives, including their cultural values, attitudes, and beliefs. Previous studies have found that clients conceal certain aspects of their lives including, but not limited to their symptoms and their feelings about the therapy process. To date, there has not been an investigation focused on whether clients conceal aspects of their cultural identities, whether some therapists are more likely to have clients conceal aspects of their cultural identities, and if cultural concealment is associated with therapy outcomes. The present study attempted to do so utilizing the caseloads of 37 therapists who treated a total of 233 clients in a university counseling center setting. Client data were collected at the end of treatment utilizing the Patient's Estimate of Improvement (PEI; Hatcher & Barends, 1996), a measure that assesses client change on domains including general functioning, symptom related distress, intimate and social relationships, work or school, feelings about oneself, behavior, control of life, and tolerance for and ability to share painful feelings. Cultural concealment was assessed via 5 items regarding the amount and circumstances under which clients withheld cultural identity based information in therapy. Results indicated that within therapists' caseloads, client's ratings of cultural concealment were negatively associated with therapy outcomes. Additionally, therapists whose clients rated more cultural concealment on average had clients with worse therapy outcomes. Lastly, there was a significant contextual effect indicating that within and between therapist cultural concealment were statistically different from one another. (PsycINFO Database Record

Racial Identity Profiles Among Suicidal Black Women: A Replication and Extension Study

“…Although myriad factors account for Black women’s underutilization of mental health services, a primary barrier is clinicians’ limited awareness of and competency related to race and culture (Thompson et al, 2004), including minimal attendance to cultural factors in suicide-risk assessments and interventions (Chu et al, 2017). Not only can these factors limit treatment engagement, but they also may mitigate treatment success (Drinane et al, 2018). Therefore, it is important for mental health practitioners to understand cultural factors (e.g., racial identity), and know how to apply culturally-relevant theories in practice in ways that (a) honor group-level cultural values and (b) acknowledge individual-level expressions of those attitudes and beliefs as this can inform culturally-responsive and individualized treatment plans (Carter & Johnson, 2019; Holden et al, 2015).…”

Strategies for Broaching the Subjects of Race, Ethnicity, and Culture

“…There is a complex interplay between counselor and client dynamics such that the counselor exhibits qualities such as interpersonal warmth and acceptance to engender safety, trust, and respect, and the client must perceive those qualities as authentic. To address the therapeutic alliance, we borrow from the multicultural orientation framework that includes three domains, two of which we describe here: cultural humility and cultural comfort (Davis et al, 2018; Drinane et al, 2018; Hook et al, 2013, 2016, Pérez‐Rojas et al, 2019). The counselor's sense of cultural humility reflects an ability to exhibit openness and curiosity toward the client's values and beliefs as opposed to an air of superiority and dismissal of the client's worldview.…”

“…Consideration of clients' REC concerns contribute to more in‐depth self‐disclosures by clients, their likelihood of returning for follow‐up sessions, and their heightened satisfaction with the counseling process (Thompson & Jenal, 1994; Zhang & Burkard, 2008). Concomitantly, clients' concealment of cultural concerns has been linked to less favorable counseling outcomes (Drinane et al, 2018). These findings suggest that counselors should assume responsibility for helping clients navigate their culture‐specific values, attitudes, beliefs, and experiences within the safety of the counseling dyad (Singh et al, 2020).…”

“…This skill is especially important for clients from marginalized groups who confront sociocultural and sociopolitical stressors that diminish their sense of well‐being. Many counselors who refrain from processing these and related concerns in meaningful and substantive ways impede their clients' ability to explore the complex manner in which oppressive forces hamper the enactment of coping and resistance mechanisms that mitigate clients' psychological distress (Day‐Vines et al, 2020; Drinane et al, 2018).…”

Cultural Humility as a Spiritually Focused Intervention in Correctional Settings: The Role of Therapists’ Multicultural Orientation

“…For instance, the culturally humble therapist honors where clients are in their process of exploring new R/S identities and works with clients in their journey. In contrast, assuming nefarious intent or disbelief about their process can change clients’ willingness to be open and feel safe in the therapy room, which is associated with worse therapy outcomes (Drinane et al, 2018).…”