Transitions in Psychotherapy, Clinical Diagnosis, and Assessment

Behavioral health psychotherapy, diagnostic, and assessment services for multicultural global populations are conspicuous in some local professional settings but have not been recognized as immediate priorities or incorporated into national policies. Nonetheless, a continuous development of multicultural skills is necessary in these practice arenas not only in the United States but also internationally to improve the psychological health of existing and emerging populations. A global society can neither prosper nor survive without conspicuous and immediate attention to the needs of these burgeoning populations. In the United States, however, recent survey results of psychotherapy conducted by culturally informed, well-intentioned White psychologists indicate pervasive therapist silence concerning potential cultural issues with their multicultural clients. Many of these clients receive monocultural services lacking sufficient cultural empathy to develop trusting relationships that encourage responsiveness to core client issues of identity, integrity and self-respect conducive to healing. These monocultural services contribute to client feelings of invisibility in a racist society, foster realistic paranoia, and dilute positive outcomes of psychotherapy.

Although clinical diagnosis now includes cultural considerations in the form of cultural formulations and recognizes culture-bound syndromes, a monocultural perspective continues to over- and underpathologize multicultural clients in the United States. Nonetheless, a multicultural perspective is emerging very slowly as a result of efforts to classify racism as a source of psychological trauma, separate pathological and nonpathological individual responses, and increasingly recognize cultural factors in symptom expression and illness experience. In Europe, the responsiveness of European Community nations to cultural issues has been mapped to encourage and facilitate the development of consensual methods to standardize mental health services while respecting the historic integrity of constituent countries.