Derald Wing Sue, PhD, co-author with psychologist David Sue, PhD, of the fourth edition of "Counseling the Culturally Diverse: Theory and Practice" (John Wiley & Sons, 2003), says psychologists who obtain greater cultural competence will only improve their treatment outcomes when working with Asian-and Pacific-American clients. Sue, a professor of psychology and education at Teachers College at Columbia University, was a co-founder and the first president of the Asian American Psychological Association.

Q: How can a therapist's lack of cultural competence impact treatment outcomes?

A: First, at best, even if no harm occurs, it means Asian-American clients may not receive needed help. The client simply does not return and continues to suffer. At worst, the therapist may impose his or her values upon the Asian-American client and engage in what I call cultural oppression. The counselor may pathologize cultural differences or values, making the client feel worse. Studies reveal that Asian-American clients underutilize traditional mental health facilities and tend to drop out-at a 50 percent rate-after only one contact with a therapist. This is in marked contrast to a less than 30 percent rate for white clients. It has been found that these high dropout rates are due to the culture-bound, class-bound and linguistic biases in therapy. Also, Asian-American clients may be misdiagnosed and given inappropriate and harmful treatments.

Q: As the number of Asian Americans and Pacific Islanders increases in the United States, how can psychology better reach out to this population?

A: Education and training in psychology programs must make a special effort to view Asian Americans and Pacific Islanders as an important group to understand. Curricula should cover this group at both preservice and in-service programs. They must be covered in texts, and psychologists must begin to create learning opportunities for themselves in Asian-American communities.

Q: Where can psychologists turn to gain more cultural competence skills?

A: There are two issues here. First, formal training through workshops and academic work is required. However, that is not enough. Cultural competence is more than cognitive and intellectual understanding. If psychologists believe they need only specialized training, they will never become culturally competent. Cultural competence must be obtained through experiential reality. In this case, intimate contact with Asian Americans, their communities and with healthy members are paramount to understanding the group. Psychologists must realize that cultural competence is not acquired just through book learning and skills training alone.

Q: Is becoming culturally competent equally important for researchers?

A: Yes. Researchers are also representatives of their culture and society. If they are unaware of how their biases and values affect what and how they ask research questions, conduct research and interpret findings, then they may perpetuate stereotypes and create a biased knowledge base.

-M. Dittmann Tracey