Stanley Sue

The Role of Culture and Cultural Techniques in Psychotherapy: A Critique and Reformulation.

This article examines the role of cultural knowledge and culture-specific techniques in the psychotherapeutic treatment of ethnic minority-group clients. Recommendations that admonish therapists to be culturally sensitive and to know the culture of the client have not been very helpful. Such recommendations often fail to specify treatment procedures and to consider within-group heterogeneity among ethnic clients. Similarly, specific techniques based on the presumed cultural values of a client are often applied regardless of their appropriateness to a particular ethnic client. It is suggested that cultural knowledge and culture-consistent strategies be linked to two basic processes— credibility and giving. Analysis of these processes can provide a meaningful method of viewing the role of culture in psychotherapy and also provides suggestions for improving psychotherapy practices, training, and research for ethnic-minority populations.

Asian-American educational achievements. A phenomenon in search of an explanation.

Considerable attention has been paid to the academic achievements of Asian Americans because there is convergent evidence that this population has attained high educational mobility. In trying to explain the achievement patterns, researchers have largely limited their investigations to one of two contrasting hypotheses involving (a) hereditary differences in intelligence between Asians and Whites and (b) Asian cultural values that promote educational endeavors. Research findings have cast serious doubt over the validity of the genetic hypothesis. Yet, there has been a failure to find strong empirical support for alternative hypothesis concerning cultural values. It is proposed, under the concept of relative functionalism, that Asian Americans perceive, and have experienced, restrictions in upward mobility in careers or jobs that are unrelated to education. Consequently, education assumes importance, above and beyond what can be predicted from cultural values. Research and policy implications of this view are noted.

Use of Mental Health–Related Services Among Immigrant and US-Born Asian Americans: Results From the National Latino and Asian American Study

OBJECTIVES We examined rates of mental health-related service use (i.e., any, general medical, and specialty mental health services) as well as subjective satisfaction with and perceived helpfulness of care in a national sample of Asian Americans, with a particular focus on immigration-related factors. METHODS Data were derived from the National Latino and Asian American Study (2002-2003). RESULTS About 8.6% of the total sample (n=2095) sought any mental health-related services; 34.1% of individuals who had a probable diagnosis sought any services. Rates of mental health-related service use, subjective satisfaction, and perceived helpfulness varied by birthplace and by generation. US-born Asian Americans demonstrated higher rates of service use than did their immigrant counterparts. Third-generation or later individuals who had a probable diagnosis had high (62.6%) rates of service use in the previous 12 months. CONCLUSIONS Asian Americans demonstrated lower rates of any type of mental health-related service use than did the general population, although there are important exceptions to this pattern according to nativity status and generation status. Our results underscore the importance of immigration-related factors in understanding service use among Asian Americans.

Science, ethnicity, and bias: where have we gone wrong?

The quality, quantity, and funding of ethnic minority research have been inadequate. One factor that has contributed to this inadequacy is the practice of scientific psychology. Although principles of psychological science involve internal and external validity, in practice psychology emphasizes internal validity in research studies. Because many psychological principles and measures have not been cross-validated with different populations, those conducting ethnic minority research often have a more difficult time demonstrating rigorous internal validity. Thus, psychologys overemphasis of internal as opposed to external validity has differentially hindered the development of ethnic minority research. To develop stronger research knowledge on ethnic minority groups, it is important that (a) all research studies address external validity issues and explicitly specify the populations to which the findings are applicable; (b) different research approaches, including the use of qualitative and ethnographic methods, be appreciated; and (c) the psychological meaning of ethnicity or race be examined in ethnic comparisons.

Immigration-related factors and mental disorders among Asian Americans.

OBJECTIVES We examined lifetime and 12-month rates of any depressive, anxiety, and substance abuse disorders in a national sample of Asian Americans. We focused on factors related to nativity and immigration as possible correlates of mental disorders. METHODS Data were derived from the National Latino and Asian American Study, the first national epidemiological survey of Asian Americans in the United States. RESULTS The relationships between immigration-related factors and mental disorders were different for men and women. Among women, nativity was strongly associated with lifetime disorders, with immigrant women having lower rates of most disorders compared with US-born women. Conversely, English proficiency was associated with mental disorders for Asian men. Asian men who spoke English proficiently generally had lower rates of lifetime and 12-month disorders compared with nonproficient speakers. CONCLUSIONS For Asian Americans, immigration-related factors were associated with mental disorders, but in different ways for men and women. Future studies will need to examine gender as an important factor in specifying the association between immigration and mental health.

Methodological Issues in Assessment Research With Ethnic Minorities

Assessment research on ethnic minorities presents multiple methodological and conceptual challenges. This article addresses the difficulties in denning and examining ethnicity as a variable in psychological research. The authors assert that many of the problems stem from not making explicit the assumptions underlying the use of ethnicity as an explanatory variable and from inadequately describing cultural and contextual characteristics of ethnic minority samples. Also raised are common methodological problems encountered in examining race, ethnicity, and culture in assessment research, such as decisions regarding which populations to study, sampling methodologies, measure selection, method of assessment, and interpretation of results. Finally, some guidelines are offered for tackling some of the methodological dilemmas in assessment research with ethnic minorities. Assessment research on ethnic minority groups has had a controversial history. For example, comparisons of intellectual abilities and cognitive skills, of self-esteem and self-hatred, of personality patterns, and of prevalence rates and degrees of psychopathology among different ethnic and racial groups have generated considerable controversy regarding the validity of findings. It is our belief that conducting valid assessment research with ethnic minority groups is particularly problematic because of methodological, conceptual, and practical difficulties that arise in such research. This article addresses common methodological problems that have plagued assessment research on ethnic minorities. Our intent here is not to provide definitive solutions to methodologica l problems but rather to raise issues that many researchers may not have otherwise considered, so that informed decisions can be made about how to handle variables related to ethnicity. We also pose some guidelines for future assessment research with ethnic minorities to improve the knowledge base not only for ethnic minorities but also for the field of psychological assessment. In doing so, we will closely examine fundamental problems such as sample heterogeneity, measurement of culture, and underlying assumptions about ethnicity, all of which make assessment research with ethnic minorities inherently challenging. Because our work involves Asian Americans, many of the cited examples deal with this population, although the point behind the examples may apply to other ethnic groups. We refer to assessment research in a broad sense and use examples from extant literature on cognitive, personality, and clinical psychodiagnostic assessment with various ethnic mi

The Case for Cultural Competency in Psychotherapeutic Interventions

Cultural competency practices have been widely adopted in the mental health field because of the disparities in the quality of services delivered to ethnic minority groups. In this review, we examine the meaning of cultural competency, positions that have been taken in favor of and against it, and the guidelines for its practice in the mental health field. Empirical research that tests the benefits of cultural competency is discussed.

Return rates and outcomes from ethnicity-specific mental health programs in Los Angeles.

OBJECTIVES The present study compared the return rate, length of treatment, and treatment outcome of ethnic minority adults who received services from ethnicity-specific or mainstream programs. METHODS The sample consisted of 1516 African Americans, 1888 Asian Americans, and 1306 Mexican Americans who used 1 of 36 predominantly White (mainstream) or 18 ethnicity-specific mental health centers in Los Angeles County over a 6-year period. Predictor variables included type of program (ethnicity specific vs mainstream), disorder, ethnic match (whether or not clients had a therapist of the same ethnicity), gender, age, and Medi-Cal eligibility. The criterion variables were return after one session, total number of sessions, and treatment outcome. RESULTS The study indicated that ethnic clients who attended ethnicity-specific programs had a higher return rate and stayed in the treatment longer than those using mainstream services. The data analyses were less clear cut when treatment outcome was examined. CONCLUSIONS The findings support the notion that ethnicity-specific programs seem to increase the continued use of mental health services among ethnic minority groups.

Culture-Specific Patterns in the Prediction of Life Satisfaction: Roles of Emotion, Relationship Quality, and Self-Esteem

This study was conducted to explore the culture-specific roles of emotion, relationship quality, and self-esteem in determining life satisfaction. It was hypothesized that maintaining good interpersonal relationships would make individuals in collectivistic cultures not only feel good about their lives but also feel better about themselves. Furthermore, two emotion variables—emotional expression and emotion differentiation—were proposed as possible determinants of relationship quality. It was hypothesized that emotional expressiveness would be more important for maintaining good interpersonal relationships in individualistic societies but emotion differentiation would be more important in collectivistic cultures. These hypotheses were tested with Euro-American, Asian American, Korean, and Chinese groups using multigroup analyses in a structural equation model. Results supported all proposed hypotheses and indicated that emotion differentiation contributes to maintaining good interpersonal relationships in collectivistic cultures, which contributes to self-esteem and satisfaction with life.

Cultural Factors in the Clinical Assessment of Asian Americans.

In view of the growing interest in the influence of cultural factors in psychological assessment, this article critically evaluates assessment issues with Asian American populations. Examined are issues in (a) the extent and symptoms of psychopathology, (b) personality assessment, and (c) face-to-face clinical assessment. It is argued that, without understanding cultural factors, researchers and practitioners may draw inappropriate and invalid conclusions. Cultural factors are important not only in providing a context for interpreting assessment outcomes but also in suggesting appropriate conceptual and methodological strategies. Suggestions are made for improving assessment strategies and for testing the limitations and generality of constructs.