CHAPTER 13 CULTURALLY COMPETENT ASSESSMENT

Introduction  It is important to accurately assess, diagnose, and treat clients.  Cultural characteristics need to be taken into account.  Counselors are not objective and do hold stereotypes and biases.

Therapist Variables Affecting Diagnosis  Some common diagnostic errors include: Confirmatory strategy Attribution errors Judgmental heuristics Diagnostic overshadowing  To guard against these, it is important for counselors to develop cultural competence (i.e., knowledge, awareness, and skills).

Contextual and Collaborative Assessment  A collaborative approach also endorses the client and counselor working together to construct an accurate definition of the problem.  The contextual viewpoint acknowledges that both the client and the counselor are embedded in systems such as family, work, and culture.

Collaborative Conceptualization Model Proceed using the following steps:  Use both clinician skill and client perspective to understand the problem.  Collaborate and jointly define the problem.  Jointly formulate a hypothesis regarding the cause of the problem.  Jointly develop ways to confirm or disconfirm the hypothesis.  Test out the hypothesis using both the client and the counselor as evaluators.  If the conceptualization appears to be valid, develop a treatment plan.  If the hypothesis is not borne out, the counselor and client collect additional data and formulate new, testable hypotheses.

Collaborating on Intervention Strategies  Intervention strategies should be based on research facilitating qualities possessed by counselors, client characteristics, and techniques.  Interventions should not be rigidly applied.  Consensus between counselor and client regarding course of therapy allows the therapeutic relationship to strengthen.  Client therefore develops confidence in the treatment as well as hope and optimism.

Culturally Sensitive Intake Interviews  Identifying information: Other than demographic information and inquiries about cultural groups to which the client feels connected, also ask about primary language use in the home.  Presenting problem: Obtain his/her perception of the problem and be sure to consider issues such as prejudice or oppression.  History of presenting problem: Get a chronological account of the problem and understand how cultural issues might be related to the problem.  Psychosocial history: Be sure to assess social background, values and belief (questions for inquiry are presented in the chapter).  Abuse history: Always ask questions around physical, sexual and emotional abuse history.

Culturally Sensitive Intake Interviews  Strengths: Identify culturally relevant strengths such as pride in one’s identity or culture.  Medical history: Assess medical or physical conditions that may be related to psychological problems; inquire about indigenous healing practices.  Substance abuse history: Assess substance and alcohol use; ask questions about family history as well.  Risk of harm to self or others: Assess harm and ask questions about clients’ emotional state.

Implications for Clinical Practice  Infuse cultural competence into assessment, diagnosis, and treatment.  Evaluate ones’ cultural competence.  Infuse cultural issues into intake interviews.  Do not stereotype clients or overgeneralize based on the information presented in the text.  Clients must be viewed in their totality, as unique individuals.