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Assessing and Treating Culturally Diverse Clients NBCC Approved

This book quickly summarizes key practical guidelines that all clinicians can apply when assessing, diagnosing, or treating culturally diverse clients. The author accents clinical work with African American, Hispanic, American Indian, and Asian clients. Some of the topics covered include a description of cultural variables in the DSM-IV that may affect assessment and treatment across groups; explanations of epidemiological mental health data across groups; a discussion on how to apply data from culturally specific, biased measures; and a description of many of the important factors to consider during the delivery of treatment. This practical volume also offers guidelines for the prevention of attrition.

About the Authors

Freddy A. Paniagua (Ph.D., University of Kansas; postdoctoral training at Johns Hopkins University School of Medicine) is Professor in the Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch at Galveston, where he teaches cross-cultural mental health seminars with an emphasis on the assessment and treament of African American, Hispanic, Asian, and American Indian clients. In 1989, he received a 6-year grant from the National Institute of Mental Health to provide training to mental health professionals representing culturally diverse groups, with emphasis on the assessment and treatment of emotionally disturbed clients. He has published more than 40 scientific articles, including reports on basic and applied research as well as theoretical contributions, and two textbooks on multicultural issues that are widely used in mental health training programs in the United States and abroad.

Learning Objectives

  1. Explain the term “minority” as referring to the group’s numbers in the population and to the socio-economic status.
  2. Explain the problems involved in the use of the term “minority” in reference to groups such as American Indians, Asian and Pacific Islanders, Hispanics and African Americans.
  3. Describe the focus in the assessment and treatment of people with mental disorders where the focus is on the emphasis in which individuals from diverse groups express their cultural values, their views of the world and their place in society.
  4. Explain the qualitative difference between the terms “race” and “ethnicity”.
  5. ist the sources of guidelines for mental-health practitioners about assessment, diagnosis and treatment of clients from diverse groups discussed in the book.
  6. Correctly explain the development of a therapeutic relationship at the cultural level using the “cultural compatibility hypothesis.”
  7. Explain the “universalistic hypothesis” as it pertains to the development of a therapeutic relationship with clients from diverse groups discussed in the book.
  8. Explain the application of acculturation process to the assessment, diagnosis, and treatment of clients from diverse cultural groups discussed in the book.
  9. Explain the models of acculturation and their common use in the treatment of clients from diverse cultural groups discussed in the book.
  10. Explain the tendency of clinicians to overdiagnose clients of diverse cultural backgrounds discussed in the book.
  11. Explain the role and importance of extended family in the lives of members of diverse cultural groups discussed in the book.
  12. Describe the most commonly used recommended forms of psychotherapy for members of African American, American Indian, Hispanic, and Asian groups.
  13. Describe the prevalence of biracial and multiracial clients in the United States population and explain the implications for the delivery of psychological services.
  14. Explain the cultural variables that may affect the assessment and treatment of African American clients.
  15. Explain the meaning of “healthy cultural paranoia” and describe the language that African American clients may use while in psychotherapy.
  16. Explain ways the therapist can minimize feelings of suspicion that African American clients may experience as a result of racial differences.
  17. Explain the propensity to diagnose African American clients with schizophrenia more readily than white clients.
  18. Explain the importance in the treatment of African American clients to reinforce the concept of “empowerment.”
  19. Explain the cultural variables that may affect the assessment and treatment of Hispanic clients.
  20. Explain the importance of exploring the level of acculturation for the assessment and treatment of Hispanic clients.
  21. Describe the most commonly recommended psychotherapy treatment modalities for Hispanic clients and explain why such modalities are recommended.
  22. Describe the different types of Hispanic families and explain the relevance to the assessment and treatment of clients of Hispanic background.
  23. Explain the cultural variables that may affect the assessment and treatment of Asian clients.
  24. Explain the process of conducting psychotherapy with Asian clients.
  25. Describe the most commonly recommended psychotherapy treatment modalities for Asian clients.
  26. Explain the cultural meanings ascribed to indirect forms of communication, such as silence and avoiding eye contact, when working with Asian clients.
  27. Explain the cultural variables that may affect the assessment and treatment of American Indian clients.
  28. Describe the recommended approach to the first psychotherapy session with an American Indian client.
  29. Describe the most commonly recommended psychotherapy treatment modalities for American Indian clients.
  30. Explain the term “attrition” in the context of assessment and treatment of culturally diverse clients.
  31. Explain the impact that lack of cultural validity of epidemiological studies has on the assessment and treatment of clients from culturally diverse backgrounds.
  32. Describe the two issues that may affect the nature of psychiatric epidemiological data and explain their respective impact upon the assessment and treatment of clients from diverse cultural backgrounds.
  33. Explain the importance for practitioners to examine their own biases and prejudices and describe what is the Self-Evaluation of Biases and Prejudices Scale.
  34. Explain the term “culture-related syndromes” in the context of assessment and treatment of culturally diverse clients.
  35. Describe Dana’s assessment model and explain its goals in the context of assessment and treatment of culturally diverse clients.
  36. Correctly define “Cultural Identity” and explain how a cultural identity conflict arises.

Course Contents

1 Minority, Race and Ethnicity Concepts

  • Minority Groups Versus Multicultural Groups
  • Discrepancies in Income Levels Across “Minority” Groups
  • Impact of “Minority” Groups on Other Groups
  • The Concept That “Minority” Equals “Inferiority”
  • Race Versus Ethnicity

2 General Guidelines for the Assessment, Diagnosis, and Treatment of Culturally Diverse Clients

  • Development of a Therapeutic Relationship
  • Acculturation
  • Use of Translators
  • Overdiagnosis of Multicultural Clients
  • Extended Family
  • Foster Homes and the Extended Family
  • Modality of Therapy
  • How Much Information Is Necessary?
  • The Meaning of Therapist Across Multicultural Groups
  • Using Data From the 2000 U.S. Census in the Clinical Context

3 Guidelines for the Assessment and Treatment of African American Clients

  • Cultural Variables That May Affect Assessment and Treatment
  • The First Session
  • Conducting Psychotherapy

4 Guidelines for the Assessment and Treatment of Hispanic Clients

  • Terminology
  • Cultural Variables That May Affect Assessment and Treatment
  • The First Session
  • Conducting Psychotherapy

5 Guidelines for the Assessment and Treatment of Asian Clients

  • Cultural Variables That May Affect Assessment and Treatment
  • The First Session
  • Conducting Psychotherapy

6 Guidelines for the Assessment and Treatment of American Indian Clients

  • What Is an “Authentic” Indian?
  • Cultural Variables That May Affect Assessment and Treatment
  • The First Session
  • Conducting Psychotherapy

7 Guidelines for the Prevention of Attrition with African American, Hispanic, Asian, and American Indian Clients

8 Guidelines for Evaluating and Using the Epidemiological Mental Health Literature with Culturally Diverse Clients

  • Lack of Uniformity in Definitions of Mental Disorders
  • Lack of Cultural Validity
  • Failure to Examine the Perception of Racial Discrimination as a Cause of Emotional Problems
  • Bias in Reporting on the Epidemiology of Mental Disorders

9 Taking Action

  • Examining Practitioner Biases and Prejudices
  • Being Aware of the Potential Effects of Racism
  • Evaluating Socioeconomic Variables
  • Minimizing the Sociocultural Gap
  • Distinguishing Culture-Related Syndromes From Cultural Variations
  • Asking Culturally Appropriate Questions
  • Consulting Paraprofessionals and Folk Healers
  • Using the Mental Status Examination in Cultural Context
  • Using the Least Biased Assessment Strategies First
  • Using Dana’s Assessment Model

10 Using Cultural Variables in the Diagnostic and Statistical Manual of Mental Disorders

  • Cultural Considerations With Other Conditions That May Be a Focus of Clinical Attention

Post-Test