July 1st, 2013

“Multicultural Care: A Clinician’s Guide to Cultural Competence”

“Multicultural Care: A Clinician’s Guide to Cultural Competence”

By Lillian Comas-Diaz

American Psychological Association

Washington, D.C., 2012

 ‘Influential’ resource covers complex learning process

Reviewed by James K. Luiselli, Ed.D., ABPP, BCBA-D

Achieving cultural competence should be a priority and career-long pursuit for mental health clinicians. In this book, Lillian Comas-Diaz bases her presentation and analysis on the American Psychological Association’s “Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists (2013).” As she acknowledges, these guidelines “highlight the respect and inclusiveness for the heritage of all cultural groups, the recognition of cultural contexts of individuals’ and groups’ experiences and the role of external forces, such as history, economics, sociology, politics, geography and ecology in people’s lives.”

The book begins with a chapter devoted to cultural self-assessment: how does a clinician become conscious of her/his reactions to culturally different people? Although instruments such as the Cultural Competence Self-Assessment Questionnaire have utility, evaluation should not be confined to a checklist or one-time rating form.

Instead, Comas-Diaz advocates a multi-faceted approach that includes personal reflection about skills, knowledge, experiences and motivation. Furthermore, such assessment is not static. It should be fluid and responsive to changing contexts and conditions.

Effective communication is at the core of multicultural competence, which the book addresses adroitly throughout. For example, Comas-Diaz urges clinicians to appraise their “communication style” in order to facilitate therapeutic encounters with clients. Some of the key considerations that she covers are avoiding idioms and slang words, not assuming that English speaking proficiency is the same as communication fluency, asking for clarification and being keenly aware of culturally encased non-verbal language.

Her suggestions about having multicultural clients tell stories are also illuminating because “when you listen to your client’s story, you allow the emerging information to shape your clinical intervention.”

Beyond self-assessment, clinicians should conduct multicultural evaluations of their clients. On this topic, the book describes a “process oriented approach” that considers ethno cultural heritage, personal journeys, social adjustment and relationships. Integral to this process is having clinicians complete a cultural genogram which is explained and illustrated in several case studies.

As anticipated, there are several chapters on building a therapeutic alliance with clients, rich with clinical expertise and pragmatic recommendations. Comas-Diaz does not adhere to a single theoretical perspective but instead, discusses social learning theory, psychoanalysis, existentialism, cognitive-behavioral therapy and family systems, among others.

I found it encouraging that she endorses contemporary evidence-based practices that, to my thinking, have contributed significantly to treatment of clinical disorders among culturally diverse populations.

One of the most intriguing sections of the book deals with culture-specific helping activities such as ethnic psychotherapies and folk healing. Having such knowledge enables clinicians to understand culture-bound syndromes and afflictions that present so frequently in ambulatory-care settings. Comas-Diaz goes so far as recommending that clinicians incorporate their clients’ healing perspectives into routine practice.

For motivated readers, the book includes a lengthy bibliography of publication references as well as information about videos that depict culturally competent clinical practices, a list of memoirs by culturally diverse authors and a glossary of relevant terminology. Additionally, there is a supplementary continuing education online course devoted to applying the APA multicultural guidelines, with emphasis on a commitment to cultural awareness and knowledge, establishing practice standards and managing organizational change and policy development.

“Multicultural Care” makes it clear that achieving cultural competence is a complex, continuous and developmental learning process. The book gives strong rationale for building cultural competence, translates concepts into actions, teaches skills and informs future directions. Comas-Diaz intended her book for graduate students, clinicians in training, novice therapists and seasoned practitioners, a wide audience to be sure, but all strongly advised to acquire and digest this needed and influential resource.

James K. Luiselli, Ed.D., ABPP, BCBA-D, is senior vice president, applied research, clinical training and peer review at the May Institute in Norwood, Mass.

By James K Luiselli EdD ABPP BCBA-D

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