Abstract
Cultural Humility and Cultural Competence When Assessing Latinx Populations
This book emphasizes the diagnosis of mental disorders in Latinx communities (American Psychiatric Association, 2022, henceforth APA, 2022) via the clinical interview and psychological testing in cultural contexts; it does not deal with the treatment of such disorders. The authors argue in Chapter 1, correctly, that cultural humility and cultural competence (Stubbe, 2020) are two dimensions mental health professional must achieve before they engage in the assessment of individuals from Latinx populations. Cultural humility is a self-learning process involving the desire of the clinician to enter in a professional relationship with a client with the clear intension (sense by the client during clinical encounters) to honor his/her belief, customs, and values associated with the culture of the client. Cultural competence can be achieved via formal training and generally involves three components: cultural awareness (e.g., understanding of one’s cultural background and how it may impact on other cultures), cultural knowledge (e.g., able to recognize cultural values, norms, and customs across different cultures), and cultural skills (e.g., proficiency in collecting critical cultural information using assessment strategies reliable and validated with culturally diverse clients). Each one of these cultural competence domains are illustrated with clinical examples across this book.
Examples of Cultural Values When Assessing Latinx Populations
In Chapter 2, the authors provide examples of cultural values clinicians should consider during the assessment of psychopathology in Latinx populations. Examples of such values include fatalismo (fatalism), machismo, marianismo, and (familism). Although each of these cultural values might negatively affect the assessment of Latinx clients, the authors suggest that familismo is the most critical to track during the assessment process. For example, the authors observe that Latinx individuals might not agree to be assessed for the presence of mental disorders requiring treatments with the goal to avoid “revealing private information regarding the family and concern of ethnicity” (p. 24). Familismo can also impact on the decision of the Latinx client to seek the help of folk healing practices (e.g., the curandero/a) to “treat” the illness, somatic or psychological, instead of seeking help from healthcare professionals who emphasize evidence-based assessment and treatment services. Chapter 2 also provides a brief discussion with emphasis on cultural concepts of distress included in the APA (2022), which are then discussed in more detail in Chapter 3 (e.g., ataques de nervios), as well as the role of acculturation in psychological assessment.
The Clinical Interview in a Cultural Context With Latinx Populations
Drs. Mercado and Venta agree that the clinical interview is an important component in the assessment of Latinx populations, but they argue (correctly) in Chapter 3 that to collect the needed information to understand the case, diagnose it, and then recommend appropriate evidence-based treatment approaches the clinical interview should consider cultural variables shared by individuals in such populations. For example, based on their own clinical experiences assessing Latinx individuals the authors observe that the clinician would be able to have the information he/she needs to understand the case if the following cultural values are considered during the interviewing process in addition to the role of familismo: respecto, sympatia, and personalismo. The client would be able to sense the clinician is recognizing these cultural values when the clinician, for example, asks the client about the language he/she prefers during the interview, referring to the client with “usted” (a respectful manner to address a Latinx client during the first clinical encounter) instead of “tu” (see Paniagua, 2014, p. 97), prior to starting the clinical interview the clinician engages in a platica (small talk unrelated to the central core of the interview), and a period of “appropriate self-disclosure” (p. 34) which can be perceived by the client as “an example of [the clinician] expressing personalismo and sympatia” (p. 34). In addition, in the case of Latinx individuals with strong religious and spirituality beliefs the authors observe that it is also important to consider these beliefs during the clinical interview with the goal to collect pertinent details about the case under consideration. Attention to these cultural values is a good sign of cultural humility the client would sense during the clinical interview.
In Chapter 3, two additional culturally sensitive recommendations are proposed. First, clinicians should avoid using structural clinical interviews with Latinx populations, because they “are based on DSM criteria which mainly capture psychopathology as it is experienced with dominant US culture, not cultures outside the United States” (p. 32). In contrast, an unstructured clinical interview would permit the clinician to identify the cultural context potentially resulting in symptoms associated with a given mental disorder. For example, Latinx women affected by the cultural value of marianismo would be expected to be submissive and obedient in the presence of Latinx men who believe in machismo. These cultural beliefs might result in diagnosing Latinx women with “dependent personality disorder” (see APA, 2022, p. 768; Paniagua, 2014, pp. 263–264). Second, clinicians should carefully attend to the client’s cultural explanation of the mental illness associated with cultural concepts/idioms of distress/culture-bound syndromes identified in the Latinx populations (APA, 2022; Comas-Díaz, 2012; Paniagua, 2014) including, for example, ataques de nervios (“attack of nerves”), mal de ojo (“evil eye”), mal puesto (“root work, hex, spells”), and susto (“fright”).
Psychometric Issues When Assessing Latinx Populations
Chapters 4 and 5 deals with psychometric issues with a long tradition in the development and use of psychological tests recommended with culturally diverse populations (see Chapters 7 and 8 in Paniagua, 2014). Chapter 4 discusses the effect of language in psychological assessment with Latinx populations, and also provides an extensive discussion regarding the possibility of inappropriate assessment and/or clinical assessment errors with these populations when basic and/or traditional psychometric properties are emphasized (e.g., reliability, validity, internal consistence, construct validity equivalence, item equivalence, metric invariance, etc.) but without considering the potential impact of cultural variables on such psychometric properties. Drs. Mercado and Venta observe that “an assessment instrument should have demonstrated both construct validity equivalence and item equivalence with respect to the client’s cultural, ethnic, or racial group before being included in an evidence-based assessment” (p. 45). In this context, the authors conclude the narrative in Chapter 4 encouraging clinicians to be sure to select psychological tests with demonstrated measurement equivalence (i.e., item equivalence and construct validity equivalence) when assessing individuals belonging to the Latinx communities and to also “consider the cultural loading and linguistic demands of instruments prior to inclusion in their evidence-based assessment batteries” (p. 45).
The narrative in Chapter 4 is then followed, in Chapter 5, with an analysis of traditional psychological tests and their use with Latinx populations. For example, in the case of cognitive measures such as, for example, the Wechler Scales for adults and children, the authors alert mental health professionals that the cognitive functioning of Latinx clients should not be assessed with such measures without a prior assessment of the client’s level of acculturation and language proficiency. Chapter 5 also includes a discussion with emphasis on two additional measurement considerations with cultural implications, namely, trauma assessment in children and adults and traditional youth psychopathology measures use with Latinx youth. Chapter 5 includes Table 5.1 with a summary of psychological tests generally use with clients from the Latinx communities, and with emphasis on three areas: the name of the instrument, the purpose of the instrument, and specific recommendations provide by Drs. Mercado and Venta with emphasis on psychometric and cultural issues.
“Troubleshooting” and Future Research
Drs. Mercado and Venta entitled Chapter 6 “troubleshooting” in which they remind readers about key areas discussed in prior chapters which may impact on the assessment of Latinx clients including, for example, additional details regarding linguistic considerations during the testing process; barriers to assessment and treatment (e.g., lack of health insurance); lack of trust; provider’s own biases; the client’s perceived prejudice and microaggression (Sue et al., 2007); unique issues when testing undocumented clients, particularly children; and working with interpreters, particularly “when cultural concepts have no linguistic equivalence. . .and the interpreter job is to convey the meaning and message with accuracy and completeness” (p. 76; see also Paniagua, 2014, pp. 22–24).
In Chapter 7, Drs. Mercado and Venta provide suggestions for future research in psychological assessment with Latinx populations including, for example, research with emphasis on within-group variability among Latinx individuals (e.g., cultural values of machismo and marianismo are not shared by all Latinx persons), and the impact of trauma, separation, and acculturation on the health of Latinx persons after migration. Drs. Mercado and Venta observe that “research with Latinx persons often utilizes samples that are small or moderately sized” (p. 90) which might minimize the assumed “power” of the statistical test utilized (i.e., rejecting a null hypothesis that is actually false; Cohen, 1988; Paniagua, 2019). In this context, the authors correctly, recommend that the experimentally appropriate way to examine within-group variability with Latinx participants in future psychological research is the selection of larger sample sizes during sampling procedures (i.e., methods used to select the sample).
Final Thought
Many books are available with emphasis on psychological assessment, and several of them include multicultural issues with emphasis on the assessment of Latinx populations (e.g., Geisinger, 2013; Groth-Marnat & Wright, 2016). Reading such books, however, would require investing a great deal of time, and busy clinicians generally do not have the time they are expected to invest reading them. An important feature of Cultural Competency in Psychological Assessment is that it provides busy clinical psychologists (and other mental health professionals) with a quick review (94 pages of text) of important cultural issues they need to know to be culturally competent when assessing persons from Latinx populations, and still be able to keep their very busy clinical schedule in the community.
