Cultural competence — loosely defined as the ability to understand, appreciate and interact with people from cultures or belief systems different from one’s own —
has been a key aspect of psychological thinking and practice for
some 50 years. It’s become such an integral part of the field that
it’s listed as one of psychology’s core competencies. The federal
government, too, views it as an important means of helping to
eliminate racial, ethnic and socioeconomic disparities in health
and mental health care.
But defining, understanding and applying cultural
competence in treatment hasn’t been easy. For one thing,
researchers are still arguing over the basic ingredients of cultural
competence and culturally competent care. What makes a
particular therapist, practice, or protocol, culturally competent?
While there is plenty of speculation on the topic, answers to
these questions are a long way from being settled.
What’s more, funding for this kind of research has generally
been scant (see sidebar for an exception). The National
Institutes of Health tends to require a biomedical aspect in
most mental health research, including that involving cultural
competence. And the one NIH institute dedicated to ethnic-minority health issues, the National Institute of Minority
Health and Health Disparities, is one of the lowest funded
NIH agencies and tends to put more money into training than
research, field leaders say.
In addition, the area has been fraught with disagreement
and controversy. Some researchers think interventions
should be more radical than they are, while critics assert
such interventions are merely another form of “political
As a result of these complexities, the science of culturally
competent treatment has tended to receive short shrift, many say.
But thanks to a range of research efforts, that has been changing,
according to an expert in the area, Utah State University
psychology professor Melanie Domenech Rodriguez, PhD.
“Psychologists of my generation, in collaboration with those
of previous generations, are working to put the science more
squarely into cultural competence and culturally competent
treatment,” she says.
This thrust to improve the scientific aspect of culturally
competent treatment research means that a central research
focus has been a pragmatic one: modifying evidence-based
treatments for different groups, otherwise known as “cultural
adaptations.” The tack follows a long period of treatment and
research experimentation beginning in the 1960s that included,
among other approaches, involving community members
integrally in treatment design and intervention.
While cultural adaptation research doesn’t take such a
complete grassroots approach, it has the distinct advantage of
appealing more to funders. Because it starts with a scientifically
validated treatment and adds components to or tweaks it, this
kind of research is easier to manage from a research perspective
than, say, creating a treatment from scratch.
“If the wheel works relatively well, I’d like to use it,” says
University of Puerto Rico psychologist Guillermo Bernal, PhD,
who with Domenech Rodriguez co-edited the 2012 APA book
“Cultural Adaptations: Tools for Evidence-Based Practice with
Bernal helped to launch this kind of research in the 1990s
when he realized he was informally adapting evidence-based
treatments to his clients anyway.
“We very consciously began looking at the protocols of
those treatments and deconstructing them in terms of cultural
metaphors and assumptions and language,” he says.
In the first study utilizing this framework, University of
Puerto Rico psychologist Jeannette Rosello, PhD, and Bernal
compared how Puerto Rican teenagers with depression
responded to culturally adapted versions of cognitive
behavioral therapy (CBT) and interpersonal therapy (IPT),
compared with peers on a wait list. Both adapted treatments
were effective and both were superior to control group
outcomes, they found (Journal of Consulting and Clinical
In a 2008 study published in Cultural Diversity and Ethnic
Minority Psychology, Rosello, Bernal and Carmen Rivera-Medina, PhD, compared adapted group and individual versions
of cognitive behavioral therapy and interpersonal theory, again
with depressed Puerto Rican teens. All were effective, but both
group and individual CBT worked faster than either form of
IPT, the team found. (These adaptations are all now part of the
Substance Abuse and Mental Health Service Administration’s
Registry of Evidence-Based Therapies, available to the public at
Other studies have shown similar successes. In a 2014 issue
of the Journal of Latina/o Psychology, Marquette University
psychology professor Robert A. Fox, PhD, and colleagues looked
at the effects of providing a culturally adapted version of their
evidence-based parenting intervention Early Pathways to at-risk
Latino children. The kids improved significantly on behavioral
and emotional measures compared with those on a waiting list,
the team found.
Meanwhile, University of California, Los Angeles, associate
professor Anna Lau, PhD, and colleagues successfully adapted
an evidence-based intervention called The Incredible Years
to Chinese-American parents. The adaptation incorporated
earlier findings about the kinds of situations most likely to spur
punitive parenting practices among Chinese-American parents,
such as distress over their children’s academic performance or
expressed desire for more autonomy. The researchers found the
adaptation fostered more positive and fewer negative parenting
practices and reduced kids’ acting out and depression (Journal
of Clinical Psychology, 2010).