Although multicultural counseling competence is crucial to the field of counseling psychology and clinical assessment, there remains a gap in how cultural data can be collected and used in clinical case conceptualization. The present study evaluated the case conceptualizations of doctoral-level trainees and focused on whether the integration of culture into the conceptualizations/formulations was influenced by the use of the Wright-Constantine Structured Cultural Interview (WCSCI), as compared to the use of one of two other cultural interviews (the Patient Cultural Identity Assessment and the DSM-5 Cultural Formulation Interview). Unsurprisingly, clients with minoritized identities and supervisors (but not trainees) with minoritized identities produced case conceptualizations that integrated culture at higher rates. Further, those conceptualizations that utilized the WCSCI were around 3.5 to 4.5 times more likely to integrate culture than those that used one of the other two cultural interviews. Implications for psychology practice are discussed.
AggarwalN. K.JarvisG. E.Gómez-CarrilloA.KirmayerL. J.Lewis-FernándezR. (2020). The cultural formulation since DSM-5: Prospects for training, research, and clinical practice. Transcultural Psychiatry, 57(4), 496–514. https://doi.org/10.1177/1363461520940481
2.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Publications.
3.
American Psychological Association. (1993). Guidelines for providers of psychological services to ethnic, linguistic, and culturally diverse populations. American Psychologist, 48(1), 45–48. https://doi.org/10.1037/0003-066X.48.1.45
BarkleyR. A. (1997). The defiant children: A clinician’s manual for assessment and parent training (2nd ed.). Guilford.
6.
BeaganB. L. (2018). A critique of cultural competence: Assumptions, limitations, and alternatives. In Cultural competence in applied psychology (pp. 123–138). Springer. https://doi.org/10.1007/978-3-319-78997-2_6
7.
BeckA. T.SteerR. A.BrownG. K. (1996). Beck Depression Inventory—Manual, (2nd ed). The Psychological Corporation.
8.
BergerL. K.ZaneN.HwangW.-C. (2014). Therapist ethnicity and treatment orientation differences in multicultural counseling competencies. Asian American Journal of Psychology, 5(1), 53–65. https://doi.org/10.1037/a0036178
9.
BernalG.AdamesC. (2017). Cultural adaptations: Conceptual, ethical, contextual, and methodological issues for working with ethnocultural and majority-world populations. Prevention Science, 18(6), 681–688. https://doi.org/10.1007/s11121-017-0806-0
10.
CabassaL. J.BaumannA. A. (2013). A two-way street: Bridging implementation science and cultural adaptations of mental health treatments. Implementation Science, 8(1), 1–14. https://doi.org/10.1186/1748-5908-8-90
11.
ChaoR. C.-L.WeiM.GoodG. E.FloresL. Y. (2011). Race/ethnicity, color-blind racial attitudes, and multicultural counseling competence: The moderating effects of multicultural counseling training. Journal of Counseling Psychology, 58(1), 72–82. https://doi.org/10.1037/a0022091
12.
ChorpitaB. F.ReiseS.WeiszJ. R.GrubbsK.BeckerK. D.KrullJ. L. (2010). Evaluation of the Brief Problem Checklist: Child and caregiver interviews to measure clinical progress. Journal of Consulting and Clinical Psychology, 78(4), 526–536. https://doi.org/10.1037/a0019602
13.
ConstantineM. G. (2001). Multicultural training, theoretical orientation, empathy, and multicultural case conceptualization ability in counselors. Journal of Mental Health Counseling, 23(4), 357–372.
14.
ConstantineM. G.LadanyN. (2001). New visions for defining and assessing multicultural counseling competence. In PonterottoJ. G.CasasJ. M.SuzukiL. A.AlexanderC. M. (Eds.), Handbook of multicultural counseling (pp. 482–498). Sage.
15.
ConstantineM. G.SueD. W. (Eds.). (2005). Strategies for building multicultural competence in mental health and educational settings. John Wiley & Sons.
16.
CookJ. M.SkaistisS. M.BordenS.NairD. (2020). Inquiring about client cultural identities: A content analysis of intake paperwork. Journal of Mental Health Counseling, 42(3), 220–233. https://doi.org/10.17744/mehc.42.3.03
17.
Crosby-CooperT.FerrellN. (2020). Culturally responsive practices: African American youth and mental health. In Implementing culturally responsive practices in education (pp. 39–56). IGI Global. https://doi.org/10.4018/978-1-7998-3331-4.ch003
18.
DadlaniM. B.OvertreeC.Perry-JenkinsM. (2012). Culture at the center: A reformulation of diagnostic assessment. Professional Psychology: Research and Practice, 43(3), 175–182. https://doi.org/10.1037/a0028152
19.
DeSilvaR.AggarwalN. K.Lewis-FernándezR. (2018). The DSM-5 Cultural Formulation Interview: Bridging barriers toward a clinically integrated cultural assessment in psychiatry. Psychiatric Annals, 48(3), 154–159. https://doi.org/10.3928/00485713-20180214-01
EasdenM. H.KazantzisN. (2018). Case conceptualization research in cognitive behavior therapy: A state of the science review. Journal of Clinical Psychology, 74(3), 356–384. https://doi.org/10.1002/jclp.22516
22.
EcklundK.JohnsonW. B. (2007). Toward cultural competence in child intake assessments. Professional Psychology: Research and Practice, 38(4), 356–362. https://doi.org/10.1037/0735-7028.38.4.356
23.
FuertesJ. N. (2012). Multicultural counseling and psychotherapy. In AltmaierE. M.HansenJ. I. C. (Eds.), The Oxford handbook of counseling psychology (pp. 570–588). Oxford University Press.
24.
FuertesJ. N.BartolomeoM.NicholsC. M. (2001). Future research directions in the study of counselor multicultural competency. Journal of Multicultural Counseling and Development, 29(1), 3–12. https://doi.org/10.1002/j.2161-1912.2001.tb00499.x
25.
González-PrendesA.HindoC.PardoY. (2011). Cultural values integration in cognitive-behavioral therapy for a Latino with depression. Clinical Case Studies, 10(5), 376–394. https://doi.org/10.1177/1534650111427075
26.
GratzK. L.RoemerL. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
27.
HaglerM. A. (2020). LGBQ-affirming and -nonaffirming supervision: Perspectives from a queer trainee. Journal of Psychotherapy Integration, 30(1), 76–83. https://doi.org/10.1037/int0000165
28.
HarrellS. P. (2000). A multidimensional conceptualization of racism-related stress: Implications for the well-being of people of color. American journal of Orthopsychiatry, 70(1), 42–57. https://doi.org/10.1037/h0087722
29.
HaysD. G. (2020). Multicultural and social justice counseling competency research: Opportunities for innovation. Journal of Counseling & Development, 98(3), 331–344. https://doi.org/10.1002/jcad.12327
30.
HaysP. A. (1996). Culturally responsive assessment with diverse older clients. Professional Psychology: Research and Practice, 27(2), 188–193. https://doi.org/10.1037/0735-7028.27.2.188
31.
HaysP. A. (2001). Addressing cultural complexities in practice. American Psychological Association.
32.
HaysP. A.IwamasaG. (2006). Culturally responsive cognitive-behavioral therapy: Assessment, practice, and supervision. American Psychological Association. https://doi.org/10.1037/11433-000
33.
HillC. E. (2014). Helping skills: Facilitating exploration, insight, and action (4th ed.). American Psychological Association.
34.
HintonD. E.HofmannS. G.RiveraE.OttoM. W.PollackM. H. (2011). Culturally adapted CBT (CA-CBT) for Latino women with treatment-resistant PTSD: A pilot study comparing CA-CBT to applied muscle relaxation. Behavior Research and Therapy, 49(4), 275–280. https://doi.org/10.1016/j.brat.2011.01.005
35.
HueyS. J.Jr.TilleyJ. L.JonesE. O.SmithC. A. (2014). The contribution of cultural competence to evidence-based care for ethnically diverse populations. Annual Review of Clinical Psychology, 10(1), 305–338. https://doi.org/10.1146/annurev-clinpsy-032813-153729
36.
HwangW.-C. (2011). Cultural adaptations: A complex interplay between clinical and cultural issues. Clinical Psychology: Science and Practice, 18(3), 238–241. https://doi.org/10.1111/j.1468-2850.2011.01255.x
37.
InmanA. G.LadanyN. (2014). Multicultural competencies in psychotherapy supervision. In LeongF. T. L.Comas-DíazL.Nagayama HallG. C.McLoydV. C.TrimbleJ. E. (Eds.), APA handbook of multicultural psychology, Vol. 2. Applications and training (pp. 643–658). American Psychological Association. https://doi.org/10.1037/14187-036
38.
JarvisG. E.KirmayerL. J.Gómez-CarrilloA.AggarwalN. K.Lewis-FernándezR. (2020). Update on the Cultural Formulation Interview. Focus, 18(1), 40–46. https://doi.org/10.1176/appi.focus.20190037
39.
JonesJ. M. (2009). Counseling with multicultural intentionality: The process of counseling and integrating client cultural variables. In The psychology of multiculturalism in the schools: A primer for practice, training, and research (pp. 191–213). National Association of School Psychologists.
40.
JonesJ. M.Kawena BegayK.NakagawaY.CevascoM.SitJ. (2016). Multicultural counseling competence training: Adding value with multicultural consultation. Journal of Educational and Psychological Consultation, 26(3), 241–265. https://doi.org/10.1080/10474412.2015.1012671
41.
JonesJ.LeeL.ZigarelliJ.NakagawaY. (2017). Culturally responsive adaptations in evidence-based treatment: The impact on client satisfaction. Contemporary School Psychology, 21(3), 211–222. https://doi.org/10.1007/s40688-016-0118-6
42.
KaufmanJ.BirmaherB.BrentD.RaoU.FlynnC.MoreciP.WilliamsonD.RyanN. (1997). Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Lifetime Version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child & Adolescent Psychiatry, 36(7), 980–988. https://doi.org/10.1097/00004583-199707000-00021
LadanyN.InmanA. G.ConstantineM. G.HofheinzE. W. (1997). Supervisee multicultural case conceptualization ability and self-reported multicultural competence as functions of supervisee racial identity and supervisor focus. Journal of Counseling Psychology, 44(3), 284–293. https://doi.org/10.1037/0022-0167.44.3.284
45.
LeeD. L.TraceyT. J. G. (2008). General and multicultural case conceptualization skills: A cross-sectional analysis of psychotherapy trainees. Psychotherapy: Theory, Research, Practice, Training, 45(4), 507–522. https://doi.org/10.1037/a0014336
46.
Lewis-FernándezR.AggarwalN. K.KirmayerL. J. (2020). The Cultural Formulation Interview: Progress to date and future directions. Transcultural Psychiatry, 57(4), 487–496. https://doi.org/10.1177/1363461520938273
47.
LópezC. M.ShealyK. M.RheingoldA. A. (2014). Empirically supported trauma treatment for an adult Latino man diagnosed with PTSD: Overcoming barriers to engagement. Clinical Case Studies, 13(5), 436–452. https://doi.org/10.1177/1534650114521282
48.
McIntoshP. (1993). Examining unearned privilege. Liberal Education, 79(1), 61–63.
MetzgerL. L. HNadkarniL. I.CornishJ. A. E. (2010). An overview of multicultural counseling competencies. In CornishJ. A. E.SchreierB. A.NadkarniL. I.MetzgerL. H.RodolfaE. R. (Eds.), Handbook of multicultural counseling competencies (pp. 1–21). Wiley.
51.
MeyerT. J.MillerM. L.MetzgerR. L.BorkovecT. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28(6), 487–495. https://doi.org/10.1016/0005-7967(90)90135-6
52.
MollenD.RidleyC. R. (2021). Rethinking multicultural counseling competence: An introduction to the major contribution. The Counseling Psychologist, 49(4), 490–503. https://doi.org/10.1177/0011000020986543
53.
MoreyL. C. (2007). Personality Assessment Inventory: Professional manual (2nd ed.). Psychological Assessment Resources.
54.
NeufeldtS. A.PinteritsE. J.MoleiroC. M.LeeT. E.YangP. H.BrodieR. E.OrlissM. J. (2006). How do graduate student therapists incorporate diversity factors in case conceptualization?Psychotherapy: Theory, Research, Practice, Training, 43(4), 464-479. https://doi.org/10.1037/0033-3204.43.4.464
55.
NevilleH.SpaniermanL.DoanB.-T. (2006). Exploring the association between color-blind racial ideology and multicultural counseling competencies. Cultural Diversity and Ethnic Minority Psychology, 12(2), 275–290. https://doi.org/10.1037/1099-9809.12.2.275
56.
O’ConnorK. J. (2000). The play therapy primer. John Wiley & Sons.
57.
OhS.Shillingford-ButlerA. (2021). The Client Assessment of Multicultural Competent Behavior (CAMCB): Development and validation. Measurement and Evaluation in Counseling and Development, 54(2), 71–89. https://doi.org/10.1080/07481756.2020.1745651
58.
PedersenP. (1990). The multicultural perspective as the fourth force in counseling. Journal of Mental Health Counseling, 12(1), 93–95.
59.
Piña-WatsonB.LópezB.OjedaL.RodriguezK. M. (2015). Cultural and cognitive predictors of academic motivation among Mexican American adolescents: Caution against discounting the impact of cultural processes. Journal of Multicultural Counseling and Development, 43(2), 109–121. https://doi.org/10.1002/j.2161-1912.2015.00068.x
60.
PowellA. (2016). Embodied multicultural assessment: An interdisciplinary training model. Drama Therapy Review, 2(1), 111–122. https://doi.org/10.1386/dtr.2.1.111_1
61.
RidleyC. R.MollenD.ConsoleK.YinC. (2021). Multicultural counseling competence: A construct in search of operationalization. The Counseling Psychologist, 49(4), 504–533. https://doi.org/10.1177/0011000020988110
62.
RidleyC. R.SahuA.ConsoleK.SuryaS.TranV.XieS.YinC. (2021). The process model of multicultural counseling competence. The Counseling Psychologist, 49(4), 534–567. https://doi.org/10.1177/0011000021992339
63.
RogersM. R.LopezE. C. (2002). Identifying critical cross-cultural school psychology competencies. Journal of School Psychology, 40(2), 115–141. https://doi.org/10.1016/S0022-4405(02)00093-6
64.
SanchezA. L.ComerJ. S.LaRocheM. (2021). Enhancing the responsiveness of family-based CBT through culturally informed case conceptualization and treatment planning. Cognitive and Behavioral Practice. https://doi.org/10.1016/j.cbpra.2021.04.003
65.
SattlerJ. M. (2020). Assessment of children: Cognitive foundations and applications (6th ed.). Jerome M Sattler.
66.
SchomburgA. M.PrietoL. R. (2011). Trainee multicultural case conceptualization ability and couples therapy. Journal of Marital and Family Therapy, 37(2), 223–235. https://doi.org/10.1111/j.1752-0606.2009.00156.x
67.
SkaistisS. M.CookJ. M.NairD.BordenS. (2018). A content analysis of intake paperwork: An exploration of how clinicians ask about gender, sex, and sexual/affectual orientation. Journal of LGBT Issues in Counseling, 12(2), 87–100. https://doi.org/10.1080/15538605.2018.1455555
68.
SmithT. B.ConstantineM. G.DunnT. W.DinehartJ. M.MontoyaJ. A. (2006). Multicultural education in the mental health professions: A meta-analytic review. Journal of Counseling Psychology, 53(1), 132–145. https://doi.org/10.10370022-0167.53.1.132
69.
SueD. W.ArredondoP.McDavisR. J. (1992). Multicultural counseling competencies and standards: A call to the profession. Journal of Multicultural Counseling and Development, 70(4), 477–486. https://doi.org/10.1002/j.1556-6676.1992.tb01642.x
SueD. W.SueD. (2012). Counseling the culturally diverse: Theory and practice (6th ed.). Wiley.
72.
TolinD. F.GilliamC.WoottonB. M.BoweW.BragdonL. B.DavisE.HannanS. E.SteinmanS. A.WordenB.HallionL. S. (2018). Psychometric properties of a structured diagnostic interview for DSM-5 anxiety, mood, and obsessive-compulsive and related disorders. Assessment, 25(1), 3–13. https://doi.org/10.1177/1073191116638410
VandiverB. J.Delgado-RomeroE. A.LiuW. M. (2021). Is multicultural counseling competence outdated or underdeveloped, or in need of refinement? A response to Ridley et al. The Counseling Psychologist, 49(4), 586–609. https://doi.org/10.1177/0011000021991877
75.
WangS.KimB. S. K. (2010). Therapist multicultural competence, Asian American participants’ cultural values, and counseling process. Journal of Counseling Psychology, 57(4), 394–401. https://doi.org/10.1037/a0020359
76.
WeatherfordR. D.SpokaneA. R. (2013). The relationship between personality dispositions, multicultural exposure, and multicultural case conceptualization ability. Training and Education in Professional Psychology, 7(3), 215–224. https://doi.org/10.1037/a0033543
77.
WeissB. J.SinghJ. S.HopeD. A. (2011). Cognitive-behavioral therapy for immigrants presenting with social anxiety disorder: Two case studies. Clinical Case Studies, 10(4), 324–342. https://doi.org/10.1177/1534650111420706
78.
WelfareL.GreasonP.MobleyK. (2017). Managed care, billing, and documentation. In YoungJ. S.CashwellC. S. (Eds.), Clinical mental health counseling: Elements of effective practice (p. 215–254). Sage. https://doi.org/10.4135/9781071801253.n11
79.
WhistonS. C. (2017). Principles and applications of assessment in counseling (5th ed.). Cengage.
80.
WilcoxM. M.FranksD. N.TaylorT. O.MonceauxC. P.HarrisK. (2020). Who’s multiculturally competent? Everybody and nobody: A multimethod examination. The Counseling Psychologist, 48(4), 466–497. https://doi.org/10.1177/0011000020904709
81.
WorthingtonR. L.DillonF. R. (2011). Deconstructing multicultural counseling competencies: Comment on Owen, Leach, Wampold, and Rodolfa. Journal of Counseling Psychology, 58(1), 10–15. https://doi.org/10.1037/a0022177
ZigarelliJ. C.JonesJ. M.PalominoC. I.KawamuraR. (2016). Culturally responsive cognitive behavioral therapy: Making the case for integrating cultural factors in evidence-based treatment. Clinical Case Studies, 15(6), 427–442. https://doi.org/10.1177/1534650116664984
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