to generate and support ideas for therapy adaptation. Hwang
then describes ways to integrate the two approaches in a
chapter in the APA book “Cultural Adaptations.” Bernal, too,
has developed an adaptation model that examines the roles of
language, cultural metaphor and acceptability of treatment to
those the adaptation is serving.
Others are adding to or modifying their work with cultural
adaptations based on experiences in the field. Lau is taking
insights gleaned in her original study — namely, therapists’ own
ideas on which types of adaptations might best suit different
families — and investigating whether and how those insights
might help sustain evidence-based interventions for youth. In a
study called 4KEEPS, she and psychologist Lauren Brookman-Frazee, PhD, of the University of California, San Diego, are
using a grant from the National Institute of Mental Health to
assess how more than 1,500 therapists in Los Angeles county are
implementing evidence-based treatments up to eight years after
initial adoption. Do they stay faithful to the original protocol?
More important, says Lau, what are therapists doing on their
own to ensure these treatments work in community settings,
and can those findings be incorporated into future treatments?
Alfiee Breland-Noble, PhD, who directs the African-American
Knowledge Optimized for Mindfully-Healthy Adolescents, or
AAKOMA, Project at Georgetown University, brings her existing
knowledge of African-American culture into treatments she
perceives are already a good fit for this population. For instance,
research shows that, for historical reasons, African-Americans can
be highly resistant to mental health treatment. That’s why Breland-
Noble starts with treatments that are more attractive to this group,
such as motivational interviewing, with its emphasis on client
empowerment. Instead of tailoring the treatment, she includes
practices that foster clients’ willingness to take part in it.
“My intervention is really designed for treatment
engagement, to increase people’s willingness to access
treatments, including culturally adapted treatments,” she says.
Researchers also are working to incorporate a more
individualized understanding of families and culture into
culturally competent intervention research and practice.
Among them is Steven Lopez, PhD, a cross-cultural psychology
researcher at the University of Southern California. He and
colleagues including Stanley Sue, PhD, distinguished professor
of clinical psychology at Palo Alto University, and others,
emphasize the importance of understanding specific factors that
inform an individual’s or family’s presenting problems — not
simply the research wisdom about their ethnic group as a whole.
To give a nuanced example, studies of Mexican-Americans
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