How do they look overall?
In general, meta-analyses confirm the effectiveness of such
One, reported by Timothy B. Smith, PhD, Domenech
Rodriguez and Bernal in a 2011 article in the Journal of Clinical
Psychology, looked at 65 experimental and quasi-experimental
studies that included some form of adapted treatment.
Adaptations for ethnic-minority clients were moderately more
effective than treatment as usual with the same clients, and
treatments with many versus few cultural adaptations were
particularly effective, they found. In addition, services targeted
to one specific group, say, Bhutanese immigrants, were several
times more effective than treatments provided to clients from a
variety of cultural backgrounds.
Another meta-analysis, reported in the Journal of Counseling
Psychology by University of Wisconsin–Madison psychologists
Steven G. Benish, PhD, Stephen Quintana, PhD, and Bruce E.
Wampold, PhD, analyzed 21 studies comparing psychotherapy
interventions that were either culturally adapted or not. The
adapted versions had better outcomes, they found.
The team also examined factors that might explain the
effectiveness of the evidence-based adapted therapies. Only
treatments that explicitly addressed a client’s own cultural views
of his or her illness had better outcomes than non-adapted
treatments. Other variables — such as treatment modality, the
ethnic match of therapist and client, and the severity of the
disorder — made little difference.
A third meta-analysis reported in the Annual Review of
Clinical Psychology in 2014 reached a more reserved conclusion.
In a summary of 10 recent meta-analyses — including those of
Smith and Benish — Stanley J. Huey Jr., PhD, of the University
of Southern California, and colleagues, found that non-adapted
psychotherapy was generally effective with ethnic-minority
clients — a finding that in part counters criticisms that
individual Western-style therapy may not be the best choice for
many ethnic-minority people.
That finding held up across cultural groups and mental
health problems. Less clear, though, was whether adding
culturally tailored strategies provided extra value. Sometimes
these additions had a positive effect, but other times their effects
were neutral or negative.
A work in progress
Mixed findings like these underscore the fact that the field
still has plenty of room to grow. To this end, researchers are
exploring areas they think are important to help advance
science and practice in cultural competence, both related and
unrelated to cultural adaptations.
For example, researchers are developing frameworks to
guide the adaptation of evidence-based treatments. Wei-Chin
Hwang, PhD, a clinical psychologist at Claremont McKenna
College, lays out principles for doing this in ways intended to
help researchers create good study designs and best incorporate
community input — known as “top down” and “bottom up”
In a 2006 article in the American Psychologist, Hwang calls
for researchers and practitioners to understand differing
cultural beliefs about mental illness and how people of different
cultures express and communicate distress, while a 2009 article
in Professional Psychology: Research and Practice provides five
steps to help researchers collaborate with community partners
Institute focuses on patients,
including their ethnicity
Researchers who conduct culturally competent
research tend to be passionate about what they
do but frustrated by a lack of funding.
“It’s very difficult to get cultural treatment
research funded that doesn’t include a biological
component,” says sociocultural researcher
Gordon C. Nagayama Hall, PhD, professor of
psychology at the University of Oregon.
There is an exception, however, field leaders
say. Called the Patient Centered Outcomes
Research Institute (see article on page 34), this
non-governmental agency, created in 2010 under
the Affordable Care Act, has received millions
of dollars to support research that is mandated
to include patients and other stakeholders in the
initial research team. In 2013 alone, the institute
funded 71 three-year research projects, or
contracts, for more than $114 million.
That includes projects with an ethnic
and sociocultural focus, says Georgetown
University psychologist Alfiee Breland-Noble,
PhD, who sits on an institute advisory board
that addresses disparities. About a fifth of
the institute’s dollars go to culturally relevant
research, she estimates.
That funders are still interested in supporting
this kind of work speaks to its important mission
of providing high-quality health and mental
health treatment for all U.S. citizens, regardless
of ethnicity or culture, she adds.
“Everyone should have the opportunity to
get care that feels relevant and OK to them,”
Breland-Noble says. “I encourage researchers
who do this work to continue to seek resources,
to seek places that are receptive to this kind of
work — and not to quit.”
— Tori DeAngelis