CHAPTER 9 MULTICULTURAL EVIDENCE-BASED PRACTICE

Evidence Based Practice and Multiculturalism The importance of evidence-based practice (EBP) is becoming increasingly accepted in the field of multicultural psychology. Although there is optimism about the convergence of these forces, there is still resistance to EBP among some individuals within the field. Conflicts often exist between the values espoused in conventional psychology and the cultural values and beliefs of ethnic minorities.

Empirically Supported Treatment Empirically supported treatment (EST) typically involves a very specific treatment protocol for specific disorders and is conducted using manuals. Cultural adaptations of ESTs are becoming common.

Empirically Supported Treatment Cultural adaptions can include factors such as: matching language, race, or ethnicity; incorporating cultural values in the specific treatment strategies; utilizing cultural sayings or metaphors in treatment; and considering the impact of environmental variables such as acculturation conflicts, discrimination, and income status.

Empirically Supported Relationships The empirically supported relationship variables include: *Strong therapeutic alliance *Strong interpersonal bond *Empathic relationship *Effective management of countertransference

Evidence-Based Practice and Diversity Issues in Therapy Evidence-based practice (EBP) refers to “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences” (APA, 2006).

Evidence-Based Practice and Diversity Issues in Therapy In EBP, the selection of intervention occurs only after individual characteristics such as cultural background, values, and preferences are assessed. Because the focus is on the client and the consideration of cultural variables, EBP sets the stage for a multiculturally sensitive counseling relationship. An illustration of how EBP and multicultural sensitivity can be integrated is provided through a case description of Anna, an American Indian female who developed PTSD following a sexual assault. In short, a trauma-focused cognitive behavioral therapy (TF-CBT) was chosen because it was seen to complement many of the traditional healing practices used in Anna’s tribe. After assessing client characteristics and values, it was determined that a cultural adaption of TF-CBT should be used. Adaptation of affect management, relaxation, cognitive coping, and enhancing the parent-child relationship aspects of TF-CBT incorporated spiritual, relational, mental and physical supports. Culturally accepted methods for telling the trauma story—including use of a journey stick, tribal danced, and storytelling procedure—were used to facilitate exposure.

Implications for Clinical Practice Know that multicultural counseling and EBP need each other to provide legitimacy. Be aware that it is essential to consider the cultural beliefs and values of the client and that relational counselor styles may need to vary according to the client’s cultural background. Know that integration of EBP and multiculturalism is resulting in an explosion of research. Mental health professionals must familiarize themselves with the literature.

Implications for Clinical Practice Identifying treatments is only one step in a complex process; considering contextual and cultural influences and therapist-client relationship factors is essential. Know that culturally competent counseling and therapy are more than a technique-driven search; the therapeutic relationship is crucial to therapeutic outcome. Be prepared to modify your therapeutic style to be consistent with the cultural values, lifestyles, and needs of culturally diverse clients.

Implications for Counseling Realize that the concept of cultural competence is more inclusive and superordinate than is the traditional definition of “clinical competence.” Realize that organizational/societal policies, practices, and structures may represent oppressive obstacles that prevent equal access and opportunity. If that is the case, systems intervention is most appropriate. Use modalities that are consistent with the lifestyles and cultural systems of clients.