The notion that culturally competent services should be available to members of ethnic minority groups has been articulated for at least four decades. Multiculturalism, diversity, and cultural competency are currently hot and important topics for mental health professionals (Pistole 2004
, Whaley & Davis 2007
). Originally conceptualized as cultural responsiveness or sensitivity, cultural competency is now advocated and, at times, mandated by professional organizations; local, state, and federal agencies; and various professions. Yet, the concept has also been a source of controversy concerning its necessity, empirical research base, and political implications. This review examines many of the key issues surrounding cultural competency—namely, its definition, rationale, empirical support, and effects. We have not attempted to be exhaustive in our review of the relevant research; instead, we have examined the major issues and trends in cultural competency.
Many prominent health care organizations are now calling for culturally competent health care and culturally competent professionals (Herman et al. 2004
). Appeals for cultural competency grew out of concerns for the status of ethnic minority group populations (i.e., African Americans, American Indians and Alaska Natives, Asian Americans, and Hispanics). These concerns were prompted by the growing diversity of the U.S. population, which necessitated changes in the mental health system to meet the different needs of multicultural populations. Further troubling were the welldocumented health status disparities between different ethnic and racial groups, as well as the nationally publicized studies regarding cultural bias in health care decision making and recommendations (Schulman et al. 1999
). The evidence revealed that mental health services were not accessible, available, or effectively delivered to these populations. Compared to white Americans, ethnic minority groups were found to underutilize services or prematurely terminate treatment (Pole et al. 2008
, Sue 1998
). Racial and ethnic minorities receive a lower quality of health care than do nonminorities, have less access to care, and are not as likely to be given effective, state-of-the-art treatments (U.S. Surgeon General 2001
). The disparities exist because of service inadequacies rather than any possible differences in need for services or access-related factors, such as insurance status (Smedley et al. 2003
Justice or ethical grounds have also propelled cultural competency (Whaley & Davis 2007
). The goals of many professional organizations include equity and fairness in the delivery of services. For example, one of the guiding principles of the American Psychological Association (2002
, pp. 1062–1063) is that:
Psychologists recognize that fairness and justice entitle all persons to access to and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists. Psychologists exercise reasonable judgment and take precautions to ensure that their potential biases, the boundaries of their competence, and the limitations of their expertise do not lead to or condone unjust practices.
has argued that cultural competence is an ethical obligation and that crosscultural skills should be placed on a level of parity with other specialized therapeutic skills. As an alternative to the passive “do no harm” approach in ethical standards in many helping professions, Hall et al. (2003)
advocated that ethical standards mandate cultural competence via collaboration with, and sometimes deference to, ethnic minority communities and experts.
The delivery of quality services is especially difficult because of cultural and institutional influences that determine the nature of services. For example, Bernal & Scharroón-Del-Río (2001)
maintain that ethnic and cultural factors should be considered in psychosocial treatments for many reasons. They propose that psychotherapy itself is a cultural phenomenon that plays a key role in the treatment process. In addition, ethnic and cultural concepts may clash with mainstream values inherent to traditional psychotherapies. The sources of treatment disparities are complex, are based on historic and contemporary inequities, and involve many players at several different levels, including health systems, their administrative and bureaucratic processes, utilization managers, health care professionals, and patients (Smedley et al. 2003
Although the problems giving rise to the cultural competency movement are multifaceted, our focus in this review is to analyze therapist and treatment tactics that are considered culturally competent. In the focus on cultural competency, we acknowledge the social and psychological diversity that exists among members of any ethnic minority group and the tendency to generalize information across distinct ethnic groups. The discussion of cultural competence issues for a particular ethnic minority group becomes even more challenging in view of the limited amount of empirically based information available on cultural influences in mental health treatment. Considering these limitations, we proceed as judiciously as we can, examining key cultural tendencies and issues likely to be encountered in psychotherapy and counseling, drawing out some implications from the extant research, and offering some suggestions for research that may produce more culturally informed mental health practices. We also recognize that culture is only one relevant factor in providing effective mental health treatment and that depending on the circumstances, other aspects of clients may be more influential. The literature reviewed represents trends that have been observed and should be considered as guidelines or working hypotheses often linked with culturally competent mental health care for ethnic minority clientele.