Crossroads: The Psychology of Immigration in the New Century

Treatment Considerations
Assessment and Diagnosis
There is extensive literature suggesting that assessment and
diagnosis are challenging when working with immigrants in
clinical settings (Comas-Díaz, 1997; Park-Taylor et al., 2010;
Vazquez-Nuttall et al., 2007). Having previously addressed
these challenges in some detail in the section on Assessment
in Clinical Settings, we now highlight a few that are directly
tied to the culturally encapsulated assessment instruments
themselves: a lack of standardized translations of assessment
instruments, as well as a lack of appropriate normative
standards and studies concerning the reliability of test scores
with various immigrant groups. From a more comprehensive
perspective, it is important that the role of sociocultural
context be comprehensively understood and seriously dealt
with in the clinical process in order to provide ethical and
appropriate standards of care in assessment, diagnosis, and
treatment.
A challenge in assessment
with immigrants is the
lack of valid and culturally
appropriate diagnostic tools
sensitive and comprehensive
enough to capture cultural
variability in the symptomatic
expression of and coping
with psychological distress.
This presents significant
challenges to psychologists
who may rely on established testing and assessment strategies
and instruments. For example, failure to take culture into
consideration can result in “clinician bias,” which may be
manifested in the tendency to universally apply Eurocentric
models of illness, contributing to overpathologizing and a lack
of attention to resilience (Dana, 1998) (see Assessment With
Immigrant-Origin Adults and Children).
It is important to note that the system of diagnosis outlined
in the fourth edition (text revision) of the Diagnostic
and Statistical Manual of Mental Disorders (DSM–IV–TR;
American Psychiatric Association, 2000) has been thought
to have universal applicability even though this diagnostic
system is culturally constructed in a way that privileges
Western or Eurocentric notions of mental illness (Pieterse
& Miller, 2010). While the most recent edition of the DSM
does offer guidelines for culture-specific diagnosis, it fails to
Immigrant Populations in Clinical Contexts
Failure to take culture into consideration
can result in “clinician bias,” which
may be manifested in the tendency to
universally apply Eurocentric models of
illness, contributing to overpathologizing
and a lack of attention to resilience.
acknowledge that the diagnostic system in the DSM–IV–TR
is culturally specific (Pieterse & Miller, 2010). The diagnostic
process itself can emphasize pathology and weakness over
resilience and resources (Atkinson, 2004). Although it is true
that the DSM–IV–TR includes a culture-specific section
in the text, an appendix of culture-bound syndromes, and
an outline for cultural formulation to enhance the crosscultural
applicability of the manual, it continues to be
insufficient in addressing cultural variability (Park-Taylor et
al., 2010; Roysircar, 2005).
Alternative diagnostic methods that supplement traditional
psychiatric diagnostic approaches can be used to better
assess and describe immigrant clients’ psychological distress
(Pedrotti & Edwards, 2010), such as looking at disorders
as lying on a continuum as opposed to being “present”
or “absent” (Oldham & Morris, 1995). Further, it is
important that clinicians self-assess the extent to which
their socialization informs their evaluation of the racial and
cultural data of the client (see
Suzuki et al., 2005).
Because of the limitations of
existing diagnostic systems,
scholars recommend that
all phases of assessment and
diagnosis, including the
clinical and/or diagnostic
interview, test administration,
interpretation, report
writing, and feedback to
the client, consider the social, cultural, and linguistic context
of immigrant clients and the coexistence of pathology
and resilience (Harvey, 2007). Clinicians should consider
the fairness and utility of diagnostic tests in the context of
language, educational background, and cultural norms. It is
also important that clinicians understand the implications of
psychological testing and diagnosis on an individual basis and
recognize that many immigrant clients are concerned about
diagnostic labels due to cultural stigma and/or immigration
status. Additionally, routine consultation with colleagues who
may be more familiar with the client’s sociocultural context,
the specific diagnostic tests being considered, and culturebound
syndromes would be especially helpful in tailoring a
culturally competent approach to assessment and diagnosis
(see Assessment Challenges).
Up to this point, assessment has mainly and quite
appropriately been addressed in reference to educational
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