Crossroads: The Psychology of Immigration in the New Century

effective than those conducted in English, culturally adapted
interventions are more effective than those not targeted
to specific cultural groups, and ethnic matching in the
therapeutic dyad is likely to improve client retention and
therapeutic outcome (Alegría, Vallas, & Pumariega, 2010; T.
Smith, Domenech Rodríguez, & Bernal, 2011). As such, it
is particularly important to understand “practice as usual”
because when evidence-based treatments are implemented,
they are integrated into existing practice settings. With
increasing pressure to implement evidence-based treatments,
providers who have been serving immigrant communities
for many years are faced with integrating their existing
practices with intervention approaches developed for
different populations than the ones they serve.
For example, the mental health clinics at the Cambridge
Health Alliance have developed ways to provide
psychotherapy that integrate psychodynamic and CBT
approaches with the client’s specific cultural beliefs and
practices. These clinics have also implemented these practices
with clients coping with mental illness and immigrationrelated
stress within constraints of limited economic
resources and managed-care models.
It is worth noting that evidence-based treatments frequently
target a particular constellation of symptoms. Although in
a university clinic, where such interventions are developed,
clients are selected to fit the intervention criteria, in
community-based clinics, providers must find treatments that
work for a range of clients seeking services. This is particularly
true for clinics that provide culturally sensitive services to
immigrants because referral to other clinics or treatments may
not be an option. As a result, evidence-based treatment must
be implemented into an overall practice model.
Research is also needed to support the continued use of
those interventions rooted in practice-based evidence.
In addition, while some graduate students in psychology
are exposed to training in community-based clinics that
provide services to immigrant communities, it is important
to consider that most graduate and postgraduate students
in psychology do not have access to training specific to
immigrants’ concerns or practice-based interventions.
Culturally Competent Treatment
According to APA, cultural competency should be an
inherent principle that underscores all work performed
by psychologists. This position is aptly presented in the
APA mission statement as well as in varied documents and
publications, including the APA Guidelines on Multicultural
Education, Training, Research, Practice and Organizational Change
(APA, 2002). The fact that these guidelines were developed
not only for individuals from minority ethnic and racial
groups but also for other groups, including immigrants,
makes them quite relevant in reference to the targeted
populations of this report.
For the sake of clarity and consistency, the definition of
culturally competent used here is the same as the one provided
in the APA’s (2010c) report on refugees: “the capacity of
programs to provide services in ways that are acceptable,
engaging, and effective with multicultural populations”
(Birman, Ho, et al., 2005, p. 12). Over the past 2 decades,
numerous researchers have addressed cultural competency
from a variety of perspectives and across differing contexts
(APA, 2002; Marmol, 2003; Mason, Benjamin, & Lewis,
1996; Nastasi, Moore, & Varjas, 2004; Pedersen, 2003; Vargas
& Koss-Chioino, 1992; Vera, Vila, & Alegría, 2003) and have
clearly shown that to obtain effective clinical outcomes, both
clinicians and the services provided need to be culturally
sensitive and competent.
Cultural competence involves three broad dimensions:
therapists’ cultural knowledge, therapists’ attitudes and beliefs
toward culturally different clients and self-understanding,
and therapists’ skills and use of culturally appropriate
interventions (Helms & Cook, 1999; D. W. Sue, Arredondo,
& McDavis, 1992). Cultural competence in practice includes
attending to actual treatment practices and promoting
access to services, such as interpreters and legal assistance. In
addition, in recent years scholars from different theoretical
orientations (e.g., cognitive–behavioral, psychodynamic,
family systems, humanistic, and integrative) have increasingly
addressed issues of diversity and cultural competence.
For example, cognitive–behavioral scholars have noted the
importance of the client’s cultural context in evaluating
thought patterns and behaviors (Hays, 2008; Newman,
2010). Psychodynamic scholars have focused on the
analysis of culturally and racially based transference and
countertransference in the therapeutic relationship (Ainslie,
2009; Comas-Díaz & Jacobsen, 1995; Tummala-Narra, 2007b).
As different types of therapy (e.g., cognitive–behavioral and
psychodynamic) have been found to be efficacious (Newman,
2010; Shedler, 2010), future research should address the ways
in which clinicians from different theoretical orientations
can further develop cultural competence to meet the mental
health needs of immigrant clients.
70 Report of the APA Presidential Task Force on Immigration