Guidelines on Multicultural Education, Training,
Research, Practice, and Organizational Change for Psychologists
American Psychological Association
Approved as APA Policy by the APA Council of Representatives, August, 2002
Practice
Guideline #5: Psychologists strive to apply culturally–appropriate skills in clinical and
other applied psychological practices.
Consistent with previous discussions in Guidelines # 1 and # 2, culturallyappropriate
psychological applications assume awareness and knowledge about one's
worldview as a cultural being and as a professional psychologist, and the worldview of
others' particularly as influenced by ethnic/racial heritage. This Guideline refers to
applying that awareness and knowledge in psychological practice. It is not necessary to
develop an entirely new repertoire of psychological skills to practice in a culture–centered
manner. Rather, it is helpful for psychologists to realize that there will likely be
situations where culture–centered adaptations in interventions and practices will be more
effective. Psychological practice is defined here as the use of psychological skills in a
variety of settings and for a variety of purposes, encompassing counseling, clinical,
school, consulting, and organizational psychology. This Guideline further suggests that
regardless of our practice site and purview of practice, psychologists are responsive to the
Ethics Code (APA, 1992). In the Preamble to the Ethics Code is language that advocates
behavior that values human welfare and basic human rights.
Psychologists are likely to find themselves increasingly engaged with others
ethnically, linguistically, and racially different from and similar to themselves as human
resource specialists, school psychologists, consultants, agency administrators, and
clinicians. Moreover, visible group membership differences (Atkinson & Hackett, 1995;
Carter, 1995; Cross, 1991; Helms, 1990; Herring, 1999; Hong & Ham, 2001; Niemann, 2001; Padilla, 1995; Santiago–Rivera et al., 2002; Sue & Sue, 1999) may belie
other identity factors also at work and strong forces in individuals' socialization process
and life experiences. These include language, gender, biracial/multiracial heritage,
spiritual/religious orientations, sexual orientation, age, disability, socioeconomic
situation, and historical life experience; e.g., immigration and refugee status (Arredondo
& Glauner, 1992; Davenport & Yurich, 1991; Espin, 1997; Hong & Ham, 2001; Lowe &
Mascher, 2001; Prendes–Lintel, 2001). Projections regarding the increasing numbers of
individuals categorized as ethnic and racial minorities have been discussed earlier in
these Guidelines. The result of these changes is that in urban, rural, and other contexts,
psychologists will interface regularly with culturally pluralistic populations (D'Andrea &
Daniels, 2001; Ellis, Arredondo, & D'Andrea, 2000; Lewis, Lewis, Daniels, &
D'Andrea, 1998; Middleton, Arredondo, & D'Andrea, 2000).
However, while Census 2000 shows that the population of the United States is
more culturally and linguistically diverse than it has ever been (U.S. Census Bureau,
2001), individuals seeking and utilizing psychological services continue to under
represent those populations. With respect to clinical/counseling services, Sue and Sue
(1999) highlighted some of the reasons for the underutilization of services, including lack
of cultural sensitivity of therapists, distrust of services by racial/ethnic clients, and the
perspective that therapy "can be used as an oppressive instrument by those in power
toÉmistreat large groups of people" (p. 7). A number of authors (Arroyo, Westerberg, &
Tonigan, 1998; Dana, 1998; Flaskreud & Liu 1991; McGoldrick, Giordano, & Pearce,
1996; Ridley, 1995; Santiago–Rivera et al., 2002; Sue, et al., 1998; Sue, Bingham,
Porche–Burke, & Vasquez, 1999; Sue & Sue, 1999) have outlined the urgent need for
clinicians to develop multicultural sensitivity and understanding.
Essentially, the concern of the authors noted above is that the traditional,
Eurocentric therapeutic and interventions models in which most therapists have been
trained are based on and designed to meet the needs of a small proportion of the
population (White, male, and middle–class persons). Ironically, the typical dyad in
psychotherapy historically was a White middle–class woman treated by a White middleclass
therapist. These authors note that Eurocentric models may not be effective in
working with other populations as well, and indeed, may do harm by mislabeling or
misdiagnosing problems and treatments.
Psychologists are encouraged to develop cultural sensitivity and understanding to
be the most effective practitioners (therapists) for all clients. The discussion that follows,
however, will primarily relate to therapeutic settings where individual, family, and group
psychotherapy interventions are likely to take place. The discussion addresses three
areas: focusing on the client within his or her cultural context, using culturally
appropriate assessment tools, and having a broad repertoire of interventions (Arredondo,
1999, 1998; Arredondo et al., 1996; Arredondo & Glauner, 1992; Costantino et al., 1994;
Dana, 1998; Duclos, Beals, Novins, Martin, Jewett, & Manson, 1998; Flores & Carey,
2000; Fouad & Brown, 2000; Hays, 1995; Ivey & Ivey, 1999; Kopelowicz, 1997; Lopez,
1989; Lukasiewicz & Harvey, 1991; Parham, White, & Ajamu, 1999; Pedersen, 1999;
Ponterotto & Pedersen, 1993; Prieto, McNeill, Walls, & Gomez, 2001; Rodriguez &
Walls, 2000; Root, 1992; Santiago–Rivera et al., 2002; Seeley, 2000; Sue, 1998; Sue,
Ivey, & Pedersen, 1996).
Client–in–context. Clients might have socialization experiences, health and
mental health issues, and workplace concerns associated with discrimination and
oppression (e.g., ethnocentrism, racism, sexism, ableism, and homophobia). Thus,
psychologists are encouraged to acquire an understanding of the ways in which these
experiences relate to presenting psychological concerns (Byars & McCubbin, 2001;
Fischer et al., 1998; Flores & Carey, 2000; Fuertes & Gretchen, 2001; Helms & Cook,
1999; Herring, 1999; Hong & Ham, 2001; Lowe & Mascher, 2001; Middleton, Rollins, &
Harley, 1999; Sanchez, 2001; Sue & Sue, 1999). This may include how the client's
worldview and cultural background(s) interact with individual, family, or group concerns.
Thus, in client treatment situations, culturally and socio–politically relevant
factors in a client's history may include: relevant generational history (e.g., number of
generations in the country, manner of coming to the country); citizenship or residency
status (e.g., number of years in the country, parental history of migration, refugee flight,
or immigration); fluency in "standard" English (and other languages or dialects); extent
of family support or disintegration of family; availability of community resources; level
of education, change in social status as a result of coming to this country (for immigrant
or refugee); work history, and level of stress related to acculturation (Arredondo, 2002;
Ruiz, 1990; Saldana, 1995; Smart & Smart, 1995). When the client is a group or
organization in an employment context, another set of factors may apply. Recognizing
these factors, culturally centered practitioners are encouraged to take into account how
contextual factors may affect the client worldview (behavior, thoughts, or feelings).
Historical experiences for various populations differ. This may be manifested in
the expression of different belief systems and value sets among clients and across age cohorts. For example, therapists are strongly encouraged to be aware of the ways that
enslavement has shaped the worldviews of African Americans (Cross, 1991; Parham et
al., 1999). At the same time, the within–group differences among African Americans and
others of African descent also suggest the importance of not assuming that all persons of
African descent will share this perspective. Thus, knowledge about sociopolitical
viewpoints and ethnic/racial identity literature would be important and extremely helpful
when working with individuals of ethnic minority descent. Culturally centered
practitioners assist clients in determining whether a "problem" stems from institutional or
societal racism (or other prejudice) or individual bias in others so that the client does not
inappropriately personalize problems (Helms & Cook, 1999; Ridley, 1995; Sue et al.,
1992). Consistent with the discussion in Guideline #2 about the effects of stigmatizing,
psychologists are urged to help clients recognize the cognitive and affective motivational
processes involved in determining whether they are targets of prejudice (Crocker et al.,
1998). Psychologists are also encouraged to be aware of the environment (neighborhood,
building, and specific office) and how this may appear to clients or employees. For
example, bilingual phone service, receptionists, magazines in the waiting room, and other
signage can demonstrate cultural and linguistic sensitivity (Arredondo, 1996; Arredondo
et al., 1996; Grieger & Ponterotto, 1998).
Psychologists are also encouraged to be aware of the role that culture may play in
the establishment and maintenance of a relationship between the client and therapist.
Culture, ethnicity, race, and gender are among the factors that may play a role in the
perception of, and expectations of therapy and the role the therapist plays (American Psychiatric Association, 1994; Carter, 1995; Comas–D’az & Jacobsen, 1991; Cooper–
Patrick et al., 1999; Seely, 2001).
Assessment. Consistent with Standard 2.04 of the APA Ethics Code (American
Psychological Association, 1992), multiculturally sensitive practitioners are encouraged
to be aware of the limitations of assessment practices, from intakes to the use of
standardized assessment instruments (Constantine, 1998; Helms, 2002; Ridley, Hill, &
Li, 1998), diagnostic methods (Ivey & Ivey, 1998; Sue, 1998), and instruments used for
employment screening and personality assessments in work settings. Clients unfamiliar
with mental health services and who hold worldviews that value relationship over task
may experience disrespect if procedures are not fully explained. Thus, if such clients do
not feel that the therapist is valuing the relationship between the therapist and client
enough, the client may not adhere to the suggestions of the therapist. Psychologists are
encouraged to know and consider the validity of a given instrument or procedure. This
includes interpreting resulting data appropriately and keeping in mind the cultural and
linguistic characteristics of the person being assessed. Culture–centered psychologists are
also encouraged to have knowledge of a test's reference population and possible
limitations of the instrument with other populations. When using standardized
assessment tools and methods, multicultural practitioners exercise critical judgment
(Sandoval, Frisby, Geisinger, Scheuneman, & Ramos–Grenier, 1998). Multiculturally
sensitive practitioners are encouraged to attend to the effects on the validity of measures
of issues related to test bias, test fairness, and cultural equivalence (APA, 1990, 1992;
Arredondo, 1999; Arredondo et al., 1996; Dana, 1998; Grieger & Ponterotto, 1995; Lopez, 1989; Paniagua, 1994, 1998; Ponterotto, Casas, Suzuki, & Alexander, 1995;
Samuda, 1998).
Interventions. Cross–culturally sensitive practitioners are encouraged to develop
skills and practices that are attuned to the unique worldview and cultural backgrounds of
clients by striving to incorporate understanding of client's ethnic, linguistic, racial, and
cultural background into therapy (American Psychiatric Association, 1994; Falicov,
1999; Flores & Carey, 2000; Fukuyama & Ferguson, 2000; Helms & Cook, 1999; Hong
& Ham, 2001; Langman, 1998; Middleton, Rollins, & Harley, 1999; Santiago–Rivera et
al., 2002). They are encouraged to become knowledgeable about the APA Guidelines for
Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse
Populations (APA, 1990) and Guidelines for Research in Ethnic Minority Communities
(CNPAAEMI, 2000). They are encouraged to learn about helping practices used in non–
Western cultures within as well as outside the North American and Northern European
context that may be appropriately included as part of psychological practice.
Multiculturally sensitive psychologists recognize that culture–specific therapy (individual,
family, and group) may require non–traditional interventions and strive to apply this
knowledge in practice (Alexander & Sussman, 1995; Fukuyama & Sevig, 1999; Ridley,
1995; Santiago–Rivera et al., 2002; Sciarra, 1999; Society for the Psychological Study of
Ethnic Minority Issues, Division 45 of the American Psychological Association &
Microtraining Associates, Inc., 2000; Sue et al., 1998; Sue & Sue, 1999). This may
include inviting recognized helpers to assist with assessment and intervention plans.
Psychologists are encouraged to participate in culturally diverse and culture–specific
activities. They are also encouraged to seek out community leaders, change agents, and influential individuals (ministers, storeowners, non–traditional healers, natural helpers),
when appropriate, enlisting their assistance with clients as part of a total family or
community–centered (healing) approach (Arredondo et al. 1996; Grieger & Ponterotto,
1998; Lewis et al., 1998).
Multiculturally sensitive and effective therapists are encouraged to examine
traditional psychotherapy practice interventions for their cultural appropriateness, e.g.,
person–centered, cognitive–behavioral, psychodynamic forms of therapy (Bernal &
Scharoon–del–Rio, 2001). They are urged to expand these interventions to include
multicultural awareness and culture–specific strategies. This may include respecting the
language preference of the client and ensures that the accurate translations of documents
occur by providing informed consent about the language in which therapy, assessments,
or other procedures will be conducted. Psychologists are also encouraged to respect the
client's boundaries by not using interpreters who are family members, authorities in the
community, or unskilled in the area of mental health practice.
