Cultural Humility with Religious and Spiritually Diverse Women of Color Clients: A Psychometric Analysis

Abstract

Cultural humility, as part of a therapist’s multicultural orientation, can help facilitate a strong working alliance with clients across diverse cultural backgrounds. Given that little research has attended to how the intersections of race/ethnicity, gender, and religion/spirituality (R/S) influence counseling dyads, we tested the factor structure and provided evidence for the reliability and construct validity of the Cultural Humility Scale (CHS) with a sample of R/S diverse women of color (N = 288). To our knowledge, this is the first study to examine the factor structure of the CHS with such a sample. We utilized a confirmatory factor analysis that revealed the original theoretical model and two-factor structure of the CHS yielded acceptable fit to the data and all items significantly loaded on their respective factors. Moreover, CHS scores had strong positive associations with client perceptions of therapists’ multicultural competencies and feminist orientation. No mean differences in perceptions of therapist cultural humility were found by R/S or racial/ethnic identity. Implications for research, theory, and clinical practice are discussed.

Keywords

cross-cultural research multicultural issues religious issues in psychotherapy

Get full access to this article

View all access options for this article.

References

American Psychological Association (2003). Guidelines for multicultural education, training, research, practice, and organizational change for psychologists. American Psychologist, 58, 377–402. doi:10.1037/0003–066X.58.5.377.

Arredondo

Toporek

Brown

S. P.

Sanchez

Locke

D. C.

Sanchez

Stadler

(1996). Operationalization of the multicultural counseling competencies. Journal of Multicultural Counseling and Development, 24, 42–78. doi:10.1002/j.2161-1912.1996.tb00288.x.

Bartoli

(2007). Religious and spiritual issues in psychotherapy practice: Training the trainer. Psychotherapy: Theory, Research, Practice, Training, 44(1), 315–321. doi:10.1037/0033-3204.44.1.54.

Beagan

B. L.

Etowa

Bernard

W. T.

(2012). “With God in our lives he gives us the strength to carry on”: African Nova Scotian women, spirituality, and racism-related stress. Mental Health, Religion & Culture, 15, 103–120, doi:10.1080/13674676.2011.560145.

Boyd-Franklin (2010). Incorporating spirituality and religion into treatment of African American clients. The Counseling Psychologist, 38, 976–1000. doi:10.1177/0011000010374881.

Cole

E. R.

(2009). Intersectionality and research in psychology. American Psychologist, 64(3), 170–180. doi:10.1037/a0014564.

Crenshaw

(1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43, 1241–1299.

Davis

D. E.

DeBlaere

Brubaker

Owen

Jordan

T. A.

Hook

J. N.

Van Tongeren

D. R.

(2016). Microaggressions and perceptions of cultural humility in counseling. Journal of Counseling & Development, 94, 483–493. doi:10.1002/jcad.12107.

Davis

D. E.

DeBlaere

Owen

Hook

J. N.

Rivera

D. P.

Choe

et al . (2018). The multicultural orientation framework: A narrative review. Psychotherapy, 55, 89–100. doi:10.1037/pst0000160.supp.

10.

Davis

D. E.

Hook

J. N.

McAnnally-Linz

Choe

Placeres

(2017). Humility, religion, and spirituality: A review of the literature. Psychology of Religion and Spirituality, 9, 242–253. doi:10.1037/rel0000111.

11.

Davis

D. E.

Hook

J. N.

Worthington

E. L.

Jr. Van Tongeren

D. R.

Gartner

A. L.

Jennings

D. J.

II Emmons

R. A.

(2011). Relational humility: Conceptualizing and measuring humility as a personality judgment. Journal of Personality Assessment, 93, 225–234. doi:10.1080/00223891.2011.558871.

12.

Davis

D. E.

Rice

Hook

J. N.

Van Tongeren

D. R.

DeBlaere

Choe

Worthington

E. L.

Jr. (2015). Development of the Sources of Spirituality Scale. Journal of Counseling Psychology, 62, 503–513. doi:10.1037/cou0000082.

13.

DeBlaere

Zelaya

D. G.

Bowie

J. A.

Chadwick

C. N.

Davis

D. E.

Hook

J. N.

Owen

(2018). Multiple microaggressions and racial/ethnic minority women in counseling: A mediational model. (Manuscript submitted for publication).

14.

Drinane

J. M.

Owen

Adelson

J. L.

Rodolfa

(2016). Multicultural competencies: What are we measuring? Psychotherapy Research, 26, 342–351. doi:10.1080/10503307.2014.983581.

15.

Fernandez

Loukas

(2014). Acculturation and religious coping as moderators of the association between discrimination and depressive symptoms among Mexican-American vocational students. Journal of Immigrant and Minority Health, 16, 1290–1293. doi:10.1007/s10903-013-9952-z.

16.

Fuertes

J. N.

Stracuzzi

T. I.

Bennett

Scheinholtz

Mislowack

Hersh

Cheng

(2006). Therapist multicultural competency: A study of therapy dyads. Psychotherapy: Theory, Research, Practice, Training, 43, 480–490. doi:10.1037/0033-3204.43.4.480.

17.

Fukuyama

Puig

Wolf

C. P.

Baggs

(2014). Exploring the intersections of religion and spirituality with race-ethnicity and gender in counseling. In Handbook of race-ethnicity and gender in psychology (pp. 23–43). doi:10.1007/978-1-4614-8860-6_2.

18.

Gash

Washington

O. G. M.

Moxley

D. P.

Feen-Calligan

(2014). The relationship between spiritual resources and life attitudes of African American homeless women. Issues in Mental Health Nursing, 35, 238–250. doi:10.3109/01612840.2013.797062.

19.

Hau

Marsh

H. W.

(2004). The use of item parcels in structural equation modelling: Non-normal data and small sample sizes. British Journal of Mathematical and Statistical Psychology, 57, 327–351. doi:10.1111/j.2044–8317.2004.tb00142.x.

20.

Helmeke

K. B.

Bischof

G. H.

(2002). Recognizing and raising spiritual and religious issues in therapy. Journal of Family Psychotherapy, 13(1), 195–214. doi:10.1300/J085v13n01_10.

21.

Hill

P. C.

Pargament

K. I.

Hood

R. W.

Jr. McCullough

M. E.

Swyers

J. P.

Larson

D. B.

Zinnbauer

B. J.

(2000). Conceptualizing religion and spirituality: Points of commonality, points of departure. Journal for the Theory of Social Behaviour, 30, 51–77. doi:10.1111/1468–5914.00119.

22.

Hook

J. N.

Davis

D. E.

Owen

DeBlaere

(2017). Cultural humility: Engaging diverse identities in therapy. Washington, D.C.: American Psychological Association.

23.

Hook

J.N.

Davis

D. E.

Owen

Worthington

E. J.

Utsey

S. O.

(2013). Cultural humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology, 60, 353–366. doi:10.1037/a0032595.

24.

Hook

J. N.

Farrell

J. E.

Davis

D. E.

DeBlaere

Van Tongeren

D. R.

Utsey

S.O.

(2016). Cultural humility and racial microaggressions in counseling. Journal of Counseling Psychology, 63, 269–277. doi:10.1037/cou0000114.

25.

Bentler

P. M.

(1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6, 1–55. doi:10.1080/10705519909540118.

26.

Johnson

S. D.

Williams

S. L.

Pickard

J. G.

(2016). Trauma, religion, and social support among African American women. Social Work & Christianity, 43, 60–73.

27.

Kim

P. Y.

(2017). Religious support mediates the racial microaggressions–mental health relation among Christian ethnic minority students. Psychology of Religion and Spirituality, 9, 148–157. doi:10.1037/rel0000076.

28.

Kim

P. Y.

Kendall

D. L.

Webb

(2015). Religious coping moderates the relation between racism and psychological well-being among Christian Asian American college students. Journal of Counseling Psychology, 62, 87–94. doi:10.1037/cou0000055.

29.

LaFromboise

T. D.

Coleman

H. L. K.

Hernandez

(1991). Development and factor structure of the Cross-Cultural Counseling Inventory—Revised. Professional Psychology: Research and Practice, 22, 380–388. doi:10.1037/0735-7028.22.5.380.

30.

Lewis-Coles

M. E. L.

Constantine

(2006). Racism-related stress, Africultural coping, and religious problem-solving among African Americans. Cultural Diversity and Ethnic Minority Psychology, 12, 433–443.

31.

Magaldi-Dopman

Park-Taylor

Ponterotto

J. G.

(2011). Psychotherapists’ spiritual, religious, atheist or agnostic identity and their practice of psychotherapy: A grounded theory study. Psychotherapy Research, 21(3), 286–30. doi:10.1080/10503307.2011.565488.

32.

Magaldi

Trub

(2018). (What) do you believe? Therapist spiritual/religious/non-religious self-disclosure. Psychotherapy Research, 28(3), 484–498. doi:10.1080/10503307.2016.1233365.

33.

McGuire

K. M.

Casanova

Davis

C. H. F.

(2016). “I’m a Black female who happens to be Muslim”: Multiple marginalities of an immigrant Black Muslim woman on a predominantly White campus. Journal of Negro Education, 85, 216–329. doi:10.7709/jnegroeducation.85.3.0316.

34.

Musgrave

C. F.

Allen

C. E.

Allen

G. J.

(2002). Spirituality and health for women of color. American Journal of Public Health, 92, 557–560. doi:10.2105/AJPH.92.4.557.

35.

Muthén

L. K.

Muthén

B. O.

(1998–2017). Mplus user’s guide (8th ed.). Los Angeles, CA: Muthén & Muthén.

36.

Nadal

K. L.

Davidoff

K. C.

Davis

L. S.

Wong

Marshall

McKenzie

(2015). A qualitative approach to intersectional microaggressions: Understanding influences of race, ethnicity, gender, sexuality, and religion. Qualitative Psychology, 2, 147–163. doi:10.1037/qup0000026.

37.

Owen

(2013). Early career perspectives on psychotherapy research and practice: Psychotherapist effects, multicultural orientation, and couple interventions. Psychotherapy, 50, 496–502. doi:10.1037/a0034617.

38.

Owen

Jordan

T. A.

II Turner

Davis

D. E.

Hook

J. N.

Leach

M. M.

(2014). Therapists’ multicultural orientation: Client perceptions of cultural humility, spiritual/religious commitment, and therapy outcomes. Journal of Psychology and Theology, 42, 91–98. doi:10.1177/009164711404200110.

39.

Owen

Tao

K. W.

Drinane

J. M.

Hook

J. N.

Davis

D. E.

Kune

N. F.

(2016). Client perceptions of therapists’ multicultural orientation: Cultural (missed) opportunities and cultural humility. Professional Psychology: Research and Practice, 47, 30–37. doi:10.1037/pro0000046.

40.

Owen

Tao

Rodolfa

(2010). Microaggressions and women in short-term psychotherapy: Initial evidence. The Counseling Psychologist, 38, 923–946. doi:10.1177/0011000010376093.

41.

Pew Research Center (2014). Religious landscape study. www.pewresearch.org

42.

Ryu

Lee

(2016). Faith, spirituality, and values among Asian-American older adults: An exploratory factor analysis of the Multidimensional Measures of Religion & Spirituality. Mental Health, Religion, and Culture, 19, 920–931. doi:10.1080/13674676.2017.1290593.

43.

Schlomer

G. L.

Bauman

Card

N. A.

(2010). Best practices for missing data management in counseling psychology. Journal of Counseling Psychology, 57, 1–10. doi:10.1037/a0018082.

44.

Tervalon

Murray-Garcia

(1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9, 117–125. doi:10.1353/hpu.2010.0233.

45.

Toscano

M. E.

(2017). Intersectionality of religion/spirituality and sexual and gender identity. Psychology of Religion and Spirituality, 9, 399–400. doi:10.1037/rel0000151.

46.

Weston

Gore

P. A.

(2006). A brief guide to Structural Equation Modeling. The Counseling Psychologist, 34, 719–751. doi:10.1177/0011000006286345.

47.

Worthington

E. L.

Jr. (1988). Understanding the values of religious clients: A model and its application to counseling. Journal of Counseling Psychology, 35, 166–174.

48.

Worthington

R. L.

Mobley

Franks

R. P.

Tan

J. A.

(2000). Multicultural counseling competencies: Verbal content, counselor attributions, and social desirability. Journal of Counseling Psychology, 47, 460–468. doi:10.1037/0022-0167.47.4.460.