As a graduate intern, Timothy B. Smith, PhD, counseled an Indian pre-med student with symptoms of depression and anxiety. Smith learned that many of the client's symptoms stemmed from the fact that he was studying medicine only because of his parents' expectations; his heart actually lay in journalism.
Smith explored the client's personal values and beliefs, but that tack didn't work. The student's depression worsened.
"I was taking an individualistic approach that was not at all appropriate with this client and I needed to incorporate the worldview of his parents," says Smith, now a psychology professor at Brigham Young University.
So, with guidance from his supervisor, Smith began to explore the client's culture and relationship with his family. Together, they developed a solution that greatly improved the student's symptoms and outlook for the future: He would continue to pursue a career as a physician while working at medical journalism on the side.
Smith was fortunate that his training supervisor was sensitive to multicultural issues, but not all students have the same experience. In fact, Smith has heard students report that their multicultural training can range from a cursory mention as part of one class to complete integration within all aspects of the program.
One thing's for certain: To provide the best care for America's increasingly diverse population, psychologists must understand how factors such as race, religion, sexual orientation, disability and class status play out in the therapeutic relationship.
"In this day and age, it's literally inexcusable to fail to train students to address the needs of all clients, because they will be serving a broad diversity of clients," says Smith.
To be APA-accredited, psychology graduate programs must include multicultural training. However, it wasn't clear whether such training produced more competent practitioners until Smith and colleagues published a 2006 meta-analysis in the Journal of Counseling Psychology (Vol. 53, No. 1). The report found that multicultural training increases multicultural competence, reduces students' racial prejudice and improves their ability to identify with clients from different backgrounds.
Even so, many students don't appreciate the value of multicultural training, says Smith. Some believe that general psychology principles apply equally to people of every background. Others attempt to work with diverse clients by taking a "colorblind" view of believing that all people are the same, which can also be harmful.
"By assuming we are all the same, you are really imposing on other people that your norms are the accurate norms," says Smith.
However, that may be changing, as students such as Gabriela Bronson-Castain not only appreciate multicultural training-they seek it out. Bronson-Castain, a fourth-year clinical psychology student, chose to attend John F. Kennedy University (JFKU), in Pleasant Hill, Calif., because the school infuses diversity into every aspect of the program. For instance, the freshmen are assigned to help out in agencies serving populations that are very different from each student's individual background. A privileged student from the rural Midwest may be assigned to an urban school in a community where gang violence and homicide are common.
"We ask the students to go into their first-year practicum sites as ethnographers. We ask them to observe and learn about the culture of the agency and population served, and reflect on how the values, worldview, belief systems and experiences that they're observing differ from their own," says Alejandrina Estrada, PhD, an associate professor in the PsyD program.
Bronson-Castain worked with mothers and their young children at a chemical dependence treatment program. There she learned how to apply her training in parenting skills to mothers struggling with drug addiction, a population she hadn't worked with before. Students report back to JFKU to share their experiences with classmates and faculty, and they write reflective papers detailing, for example, imagining what it is like to live as one of the people they encounter, such as a homeless person with a serious mental disorder who shows up at a soup kitchen for a meal.
Other training programs that make multiculturalism a priority include winners of APA's Suinn Minority Achievement Awards, which are given each year to departments that demonstrate excellence in the recruitment, retention and graduation of ethnic-minority students.
The 2007 winners include Wright State University, which integrates diversity into core courses, boasts of a diversity inclusion committee that focuses on ethnic minority issues and has a 45 percent minority-student population in its School of Professional Psychology. At Lehigh University, another award winner, 48 percent of all enrolled students enrolled are of an ethnic- minority background, and the school created a diversity task force to foster diversity in all classes. In fact, Lehigh has implemented a required multiculturalism class that's even taught outside the psychology program.
STEPS TO TAKE
To ensure they'll get solid multicultural training, Estrada advises students who are still choosing their graduate programs to look for diversity within the faculty and to make sure diversity training is featured in the program's mission statement.
"Ask how the mission statement is integrated into the curriculum and be informed of practicum opportunities where students can practice what's being taught in the classroom," she says.
For students already in school who wish to further their multicultural skills, experts advise students to:
Check out proposed classreadings. Classes that are based on sound theory and existing research will be twice as effective as those that are not, according to research by Smith. Before class begins, he suggests that students request the instructor's syllabi and make sure that the cited journal articles and books reflect diverse experiences and multicultural research.
Know thyself. Be aware of how your background shapes your views, feelings and your behavior toward others, says JFK professor Kristin Hancock, PhD. Notice the privileges you're granted on the basis of your race, gender, family status, religion or sexual orientation. For example, heterosexual couples have the privilege of legal marriage, says Hancock, while most lesbian and gay couples do not.
Advocate for more. If students feel their programs lack sufficient multicultural training, they should schedule a meeting with faculty and program directors to make their desires known. More often than not, faculty and directors are receptive to adding multicultural readings or courses or even allowing students to take such courses at other colleges and transfer the credits, says Smith.
Seek out supplemental material. Start with APA's Multicultural Guidelines (see sidebar), and then hit the library in search of books on diversity, multicultural training, gender roles, disability, world religions and race issues. For those particularly interested in lesbian, gay, bisexual and transgender clients, Marvin Goldfried, PhD, of the State University of New York, Stony Brook, recently collected journal articles on various aspects of working with LGBT populations into an easily accessible bibliography complete with abstracts. Visit www.sunysb.edu/affirm (click on Announcements, then go to Bibliographies).
Be a lifelong learner. It's not just the training that students receive in graduate school that will magically make them multiculturally competent practitioners, says Smith, who suggests that practitioners seek out continuing-education classes online or through regional or national conferences.
And, it's not possible to feel multiculturally competent if the definition is knowing about all and every single one of the differences in the world, which is impossible, adds Estrada. "But what we strive toward is multicultural proficiency in one's attitude and approach to this whole area of differences," she says. "It's about changing one's attitude in terms of willingness andability and attentiveness. And that is achievable."