Cultural Complexity in Psychotherapy

In Cultural Complexity in Psychotherapy, Dr. Pamela Hays demonstrates and discusses a culturally responsive approach to cognitive behavior therapy informed by her ADDRESSING framework.

The ADDRESSING framework calls attention to nine influences and related identities: Age and generational influences, developmental or other disability, religion and spirituality, ethnic and racial identity, socioeconomic status, sexual orientation, indigenous heritage, national origin, and gender. This framework can be used with any therapeutic approach as a way to incorporate cultural identity into the therapist’s understanding of the client and the therapeutic material. The session contained in this video program shows how the ADDRESSING framework highlights intersectional identities in therapy. For example, Dr. Hays simultaneously validates the client’s relationship with a woman and links the concept of Compassion Voice to the client’s religious beliefs via questions that help her consider a more accepting and loving approach to herself. Bracketing the session is an interview conducted by Dr. Anu Asnaani in which Dr. Hays comments on the demonstration session and explains the importance of the therapist’s ongoing personal work of becoming more culturally aware and knowledgeable.

This demonstration features a client portrayed by an actor on the basis of a composite of different cases.

In this session, Dr. Pamela Hays demonstrates her culturally responsive approach to cognitive behavior therapy informed by the ADDRESSING framework which calls attention to nine influences and related identities: age and generational influences, developmental or other disability, religion and spirituality, ethnic and racial identity, socioeconomic status, sexual orientation, indigenous heritage, national origin, and gender. In everyday language, Dr. Hays explains this approach as consisting of two broad categories of solutions. The first category of “Action Steps” includes behavioral and environmental changes that involve taking action. Attention to the client’s environment opens the door for recognition of racism, heterosexism, ableism, and other oppressive systems affecting the client. Dr. Hays acknowledges the hardships this client faced during her immigration and divorce. She also validates the client’s new first relationship with a woman without assuming how the client identifies (i.e., as gay, bisexual, heterosexual, or other identity). Regarding the client’s conflict with her disapproving mother, Dr. Hays offers the possibility of helping with behavioral changes aimed at improving the relationship with her mother, including the possibility of a family session.

The second category of solutions consists of mental changes including changes in the content and pattern of thoughts and images. Dr. Hays explains that we all seem to have at least two voices in our head—a helpful one and an unhelpful one. The unhelpful voice is harsh, judgmental, and unforgiving. Our helpful, “compassion voice” is encouraging, understanding, and kind. While simultaneously validating the client’s relationship with a woman, Dr. Hays links the concept of Compassion Voice to the client’s religious beliefs via questions that help her consider a more accepting and loving approach to herself. The session concludes with an explanation of the “smallest possible step” homework that gradually builds and reinforces change over time.

Pamela A. Hays holds a PhD in clinical psychology from the University of Hawaii and served as NIMH postdoctoral fellow at the University of Rochester School of Medicine, followed by 11 years on the graduate faculty of Antioch University Seattle.

Her research has focused on multicultural practice, including work with Tunisian women in North Africa, and Vietnamese, Lao, and Cambodian people in the US. In 2000, she returned to her hometown on the Kenai Peninsula of Alaska where she has worked with the local community health center, for the Kenaitze Tribe’s Dena’ina Wellness Center, and in private practice.

She is the author of several books including Addressing Cultural Complexities in Counseling and Clinical Practice (2022); Creating Well-Being: Four Steps to a Happier Healthier Life (2014); Connecting across Cultures: The Helper’s Toolkit (2013); coeditor of Culturally Responsive Cognitive Behavior Therapy (2019) and co-author of Cognitive-Behavioral Therapy: Techniques and Strategies.

APA has produced numerous training videos of her work demonstrating culturally responsive practice. For more information on her clinical practice, publications, videos, and workshops, visit her websiteopens in new window. 

APA Videos

Culturally Responsive Cognitive–Behavioral Therapy in Practice 
With Pamela A. Hays

Working With Clients With Physical Disabilities
With Linda R. Mona, PhD

Inclusive Cultural Empathy in Practice
With Paul B. Pedersen and Jon Carlson

Multicultural Therapy Over Time
With Melba J. T. Vasquez

Problem Solving
With Keith S. Dobson, Pamela A. Hays, and Amy Wenzel

Affirmative Psychotherapy With Gay Clients
With Kathleen J. Bieschke

APA Books

Addressing Cultural Complexities in Counseling and Clinical Practice: An Intersectional Approach, Fourth Edition 
By Pamela A. Hays

Treating Depression, Anxiety, and Stress in Ethnic and Racial Groups: Cognitive Behavioral Approaches 
Edited by Edward C. Chang, Christina A. Downey, Jameson K. Hirsch, and Elizabeth A. Yu

Culturally Responsive Cognitive Behavior Therapy: Practice and Supervision, Second Edition
Edited by Gayle Y. Iwamasa and Pamela A. Hays

Creating Well-Being: Four Steps to a Happier, Healthier Life
By Pamela A. Hays, PhD

Multicultural Feminist Therapy: Helping Adolescent Girls of Color to Thrive 
Edited by Thema Bryant-Davis

Child and Adolescent Development in Cultural Context 
By Jennifer E. Lansford, Doran C. French, and Mary Gauvain