New Study Uses Clinical Scenarios to Measure Therapists’ Multicultural Skills

Racial, ethnic, sexual, and religious orientations vary widely in our diverse society. Clinicians are trained to recognize these differences and be sensitive to how they can impact an individual’s mental health. They are taught unique ways to determine if cultural concerns belie psychological symptoms. The mental health field measures the cultural competency of clinicians based on the Multicultural Case Conceptualization (MCC) skills scale. However, the existing evidence of competence is limited. To get a broader and more comprehensive assessment of how culturally skilled clinicians are, Debbiesiu L. Lee, Assistant Professor of the Counseling Psychology Program at the University of Miami, recently led a study that employed real-life client scenarios.

Unlike other methods that have been used in the past, this most recent study considered the content of the therapeutic session in relation to multicultural issues and then analyzed the clinician’s evaluation. Lee enlisted 61 clinicians who varied in level of training, experience, and race. She looked at how each clinician interacted with the clients and how much focus they put on cultural relevance, whether it was implied or explicit. She found that the clinicians were only inclined to focus on cultural issues when they were clearly stated as being a source of concern, regardless of experience or level of training. This trend was evident even when the mock clients expressed issues of concern that could have cultural underpinnings, such as being passed over for a promotion or being the victim of abuse.

Lee believes that the cultural issues such as discrimination and violence could be relevant to many different situations that present as issues during therapy. When she compared clinicians with higher amounts of multicultural training to those with limited training, she found the same trend. In fact, the only significant difference in MCC skills appeared when she compared the ethnicity of the clinicians. She found that the clinicians of color were more sensitive to cultural causes than the white clinicians. Lee believes the findings of her study demonstrate the importance of incorporating techniques that mimic reality when assessing clinician competency. She said, “By tailoring research studies to more accurately represent real-life scenarios, it is possible that we can come to a better understanding of how multicultural orientation and competence develops in psychotherapy trainees.”

Lee, D. L., Sheridan, D. J., Rosen, A. D., Jones, I. (2012). Psychotherapy trainees’ multicultural case conceptualization content: Thematic differences across three cases. Psychotherapy: Theory, Research, Practice, Training. Advance online publication. doi: 10.1037/a0028242

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  • Randall


    July 12th, 2012 at 11:19 AM

    I too have found that people of color in general are far more sympathetic to the causes that face others like us, like discrimination or profiling.

    That’s not to say that there are no Caucasions who are not also sympathetic to the cause; it is simply that in my own experience that has been particularly hard to find.

    I want someone with whom I can share my experiences and who will understand, not just because I tell them about them but because they may have been through the same thing before. Sometimes that kind of real world experience far outweighs just the fact that someone is sympathetic to you.

  • Rochelle


    July 12th, 2012 at 12:29 PM

    I like that measuring clinicians multicultural competency and response to those issues in treatment made it to ‘Therapy News’. I work with another clinician of a different ethnicity and culture and we’re constantly discussing how even the most seemingly minute comment or implication affects treatment and what it says about ourselves and how we view the client. While our agency encourages this sort of discussion in a group setting, our comments rarely escape our office. In part, because we feel ‘safe’ and are in a space of non-judgement.
    Another area that resonated with me was the notion that clinicans of color tend to be more sensitive to cultural causes than white clinicians – since I notice that same sensitivity in my client ineractions!

  • capers


    July 12th, 2012 at 5:01 PM

    Giving therapists the chance to work with scenarios that represent real life situations are a wonderful training tool for enhancing not only their therapeutic skills, but also the chance to heighten their understanding of multicultural isssues as well. Having the opportunity to receive feedback form their peers and other professionals can be a fantastic opportunity for them to learn and to grow. Their practices will thrive as a result, but more importnatly the lives of their patients will then thrive too.

  • Rickie


    July 13th, 2012 at 4:29 AM

    Don’t you feel that in some ways therapists, just like the rest of us, will either be sensitive to these issues or not? That “training” them to be more sensitive is not necessarily the answer. You can hardly weed out those lifetimes of prejudices simply through multicultural education sessions. This takes real work on their part to change and become more sensitive to the discriminations and adversity that others may face that they need to address and be more attentive to.

  • Arnold.F


    July 13th, 2012 at 4:38 AM

    Well if a clinician has experience dealing with people of a different ethnicity than his/her own then i think they can build up these skills gradually. And if they do not have enough practice behind them then maybe they can watch videos and learn.Would this be a good idea?

  • Rochelle


    July 13th, 2012 at 9:07 AM

    @Rickie – I totally get that. Sometimes ‘training’ -exposure, discussion, self-analysis, examination – is what it takes at least in the beginning.
    While in graduate school, I remember being on the wailist for a class called ‘Internalized Oppression’. I also remember the entire campus buzzing at it because you got to really ‘do the work’ and not simply be ‘trained’ in certain skill set. It was by far the most healing experience I’ve ever had with a group of people about various types of opression – ethnic, racial, gender, ableism, etc… So, I consider that (among other things) my ‘real work’ but man, was it tough!

  • yolanda


    July 14th, 2012 at 4:27 AM

    Hi Rochelle- that class that you took sounds like something that all of us could benefit from, grad school or not! I know that I don’t think of myself as a prejudiced person, but I know that wehn I look deep enough it is there. Same thing with anyone in any profession. That sounds like a class that would help you to not only identify those hidden prejudices that you hold but also give you valuable ways to confront those when they are presented to you in situations where you cannot believe that way. I like to be challenged and provoked a little, because that is where I think many of us do our best work. Sometimes it is hard to admit that we all have these prejudices and stereotypes, and whether or not you think you have those supressed or act on them, if you are working with a patient you never know if they are sensing just how you really feel inside and how harmful that could be to him or her.

  • KIM


    July 14th, 2012 at 1:35 PM

    Well I immigrated to the States almost three decades ago and although my English is good,i would feel a lot more comfortable talking to a therapist in my mother tongue.its just that human element you know that makes you lean towards being comfortable with somebody who can connect to you in any which way possible.The more the connect the greater the level of comfort.

  • rochelle


    July 14th, 2012 at 1:51 PM

    Yolanda – I still think of some of the life lessons I learned from taking Internalized Oppression (IO). If you’re seriously interested in jolting your cultural and ethnic perceptions pick up Ronald Takaki’s ‘A Different Mirror’. You’ll way away with a new lens :)

  • Parsons


    July 16th, 2012 at 4:16 AM

    So some of these therapists are not really in tune at all with multicultural affairs unless the problem is explicitly stated by the client?
    I’m sorry but don’t you think that they should be able to read between the lines a little better than that?
    From the looks of the study here, if the patient did not clearly say that he felt discrmintaed against, then the therapists had a harder time drawing out the fact that the patient could be feeling cultural pressures that may not have been previously considered.

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