Multicultural Care in Practice
For individuals in the U.S. & U.S. territories
Culture influences how a client develops and expresses emotional distress and how that distress is healed through therapeutic intervention. Multicultural Care in Practice emphasizes culturally adapting psychotherapy to the needs of the clients, employing cultural competence to maximally connect with clients.
Becoming culturally competent involves a clinical commitment to gaining knowledge and awareness of the client's attitudes, which enables the clinician to intellectually, affectively, and culturally empathize with the client and demonstrate cultural sensitivity — showing awareness, interest, and commitment to recognizing the client's culture in all aspects of the therapeutic relationship.
Multicultural care practitioners recognize the importance of clinical competence. However, they also recognize the value of cultural competence, and research indicates that clients who perceive their therapist to be culturally competent have better outcomes in therapy.
In this demonstration, Dr. Lillian Comas-Díaz works with an African American woman who is making a decision about dating a partner outside of her own culture. Dr. Comas-Díaz demonstrates cultural empathy in working with the client, discussing how this decision will impact the client's relationship with her family and how to preserve that relationship while remaining true to herself.
Multicultural care in psychotherapy recognizes that culture is like the air we breathe — it really shapes everything, it permeates all life. Culture shapes the way we get sick, the way we interpret our distress, the way we think we're going to heal, the way we see our healers.
This approach examines human diversity dynamics and processes in a contextualized manner. Some of these constructs include self–world relationships, identity, transculturation, and ethnocultural transference and countertransference.
Culturally competent clinicians need to engage in cultural self-assessment, and they have to commit to an ongoing process of examining the realities of how culturally imbedded we are, we all are, patients and also clinicians. Also of importance is the awareness of what we don't know at all, a willingness to not only work with culturally diverse individuals but also to learn from our clients. The recognition, recovery, and use of the client's strengths are centrally important tenets to this approach.
Because we are all culturally diverse, every interaction — including clinical interaction — is cross-cultural in nature. So if we aim to be culturally competent, that's a way of being a better clinician. In fact many scholars say that cultural competence is super-ordinate to clinical confidence because it embraces everything.
In working with culturally diverse clients, the priorities are to be empathic, to aim to be culturally competent, to be present, and to have a willingness to understand the cultural background of the client.
Lillian Comas-Díaz, PhD, is a clinical psychologist in full-time private practice and a clinical professor in the George Washington University Department of Psychiatry and Behavioral Sciences. Previously, she was a faculty member of the Yale University Department of Psychiatry, where she also directed its Hispanic Clinic.
The author of more than 100 publications, Dr. Comas-Díaz is the coeditor of Clinical Guidelines in Cross-Cultural Mental Health (with Ezra Griffith, 1988), Women of Color: Integrating Ethnic and Gender Identities in Psychotherapy (with Beverly Greene, 1994), WomanSoul: The Inner Life of Women's Spirituality (with Carole A. Rayburn, 2008), and Women Psychotherapists: Journeys in Healing (with Marcella Bakur Weiner, 2011).
She is the founding editor of Cultural Diversity and Ethnic Minority Psychology, the official journal of the Society for the Psychological Study of Culture, Ethnicity and Race (APA Division 45). In addition, she serves on several editorial boards and is an associate editor of American Psychologist.
Dr. Comas-Díaz is a past president of Psychologists in Independent Practice (APA Division 42) and former director of the APA Office of Ethnic Minority Affairs.
- Comas-Díaz, L. (2012). Multicultural care: A clinician's guide to cultural competence. Washington, DC: American Psychological Association.
- Comas-Díaz, L. (Eds.). (1994). Women of color: Integrating ethnic and gender identities in psychotherapy. New York, NY: Guilford Press.
- Comas-Díaz, L., & Griffith, E. H. E. (Eds.). (1988). Clinical guidelines in cross cultural mental health. New York, NY: Wiley.
- Comas-Díaz, L., & Jacobsen, F. M. (1991). Ethnocultural transference and countertransference in the therapeutic dyad. American Journal of Orthopsychiatry, 61(3), 392–402.
- Comas-Díaz, L., & Jacobsen, F. M. (1987). Ethnocultural identification in psychotherapy. Psychiatry, 50(3), 232–241.
- Comas-Díaz, L., & Lykes, B., & Alarcon, R. (1998). Ethnic conflict and the psychology of liberation in Guatemala, Peru and Puerto Rico. American Psychologist, 53, 778-792.
- Ho, M. H. (1987). Family therapy with ethnic minorities. Newbury Park, CA: Sage.
- Jacobsen, F. M. (1988). Ethnocultural assessment. In L. Comas-Diaz & E. H. E. Griffith (Eds.), Clinical guidelines in cross cultural mental health. New York, NY: Wiley.
- Pinderhughes, E. (1989). Understanding race, ethnicity and power: The key to efficacy in clinical practice. New York, NY: Free Press.
- Rayburn, C., & Comas-Díaz, L. (Eds.). (2008). WomanSoul: The inner life of women's spirituality. Westport, CT: Praeger.
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Pamela A. Hays
- Ethnocultural Psychotherapy
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Paul B. Pedersen and Jon Carlson
- Mixed-Race Identities
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- Working With Issues of Social Class in Psychotherapy
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- Addressing Cultural Complexities in Practice, Second Edition: Assessment, Diagnosis, and Therapy
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- Cultural Adaptations: Tools for Evidence-Based Practice With Diverse Populations
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- Dialogues on Difference: Studies of Diversity in the Therapeutic Relationship
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- Inclusive Cultural Empathy: Making Relationships Central in Counseling and Psychotherapy
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- Internationalizing Multiculturalism: Expanding Professional Competencies in a Globalized World
Edited by Rodney L. Lowman
- Multicultural Care: A Clinician's Guide to Cultural Competence