with serious mental illness suggest these clients tend to relapse
when they return to family members who are inclined toward
emotional over-involvement. Studies of European-Americans
show they fare worse when they return to homes high in criticism.
But it would be a mistake to assume that emotional over-involvement is always a relapse trigger for Mexican-American
clients, or that high levels of family criticism always predict
relapse in European-American clients, says Lopez. Instead, it’s
important to assess individual families and see what the likely
predictors might be for that particular family.
“We are not saying we need a cultural adaptation for
Mexican-Americans that includes emotional over-involvement,”
he says. “It’s too static, too set, too stereotyping and it’s not
Also at issue is whether it’s desirable or even possible to gain
specific cultural competence in more than one or two cultures.
For instance, although Domenech Rodriguez has spent 18
years collaborating on interventions with partners in Mexico,
she continues to learn important lessons about that country’s
enormous cultural diversity.
“I can’t imagine trying to develop the nuances of knowledge
I have had to acquire in Mexico with every group imaginable,”
Finally, the still-murky definition of cultural competence
continues to stymie efforts to properly design studies in the
area. To this end, Domenech Rodriguez favors the idea of
observing master practitioners and seeing what they have in
common. “We really need to do some observational work with
people we agree are exquisitely culturally competent,” she says.
In a related vein, Sue, Huey and others suggest the approach
of first looking at study outcomes, then seeing which factors
distinguish those that are particularly effective with ethnic-minority clients.
“We obviously have the usual kinds of recommendations —
we need more randomized controlled trials,” says Sue. “But I
think we should try to get some insights in different ways, such
as using specific qualitative strategies.”
In some ways, it’s a plus that the field is still in a major mode
of questioning, Sue adds.
“It means people will keep on studying and analyzing cultural
competence and culturally competent interventions,” he says.
The result, he believes, will be more helpful and empirically
grounded interventions. n
Tori DeAngelis is a journalist in Syracuse, New York.
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