Behavioral Treatment of Minorities

Description of the Strategy

Diversity is not a treatment or assessment strategy; rather, it is an issue that ought to inform treatment and assessment. Diversity both within the United States and worldwide will increasingly challenge mental health professionals. Within the United States, for example, people of European background have comprised the majority ethnic and cultural group in the United States for some time. However, the demographic [Page 165]patterns in the United States are projected to continue to see a shift from European immigrants to immigrants from Asia, Latin America, and the Pacific Islands, among others. Given current trends, by 2010, more than half the population of the United States will include members of visible racial and ethnic groups who do not share European backgrounds. For example, in 1980, 85% of all immigrants were Asian and Hispanic, and less than 6% were European. Residents of Hispanic origin are projected to replace African Americans as the largest United States minority within the first two decades of the 21st century. Demographic shifts can be seen in many nations worldwide due to cross-immigration and globalization of the world economy.

In addition to issues of race, ethnicity, and culture, clinicians are becoming increasingly sensitive to differences among subgroups within the population that may influence treatment and assessment decisions. For example, some individuals may self-identify as members of the gay and lesbian community. These individuals experience different levels of acceptance from the community at large compared with individuals more identified with the cultural mainstream. Behavior therapists may need to interpret psychological difficulties differently in light of these variations in context. For example, a gay man living openly in a community with strong biases against same-sex intimate relationships may experience harassment and discrimination that could add to the overall experienced life stressors relative to other members of the same community.

Finally, individuals from different regions of the United States and from different socioeconomic backgrounds may show differences in cultural practices and beliefs compared with populations used to norm our assessment instruments and to validate our treatment strategies. For example, in the southern region of the United States, church-centered activities are frequently the center of an individual's social network. Among such groups, solutions from the spiritual community, such as pastoral counseling, prayer requests, and consultation with church elders, may be far more acceptable than seeking professional psychological services. Therefore, members of an individual's social network may view the act of seeking psychological services very differently compared with the same help seeking in another sociocultural subgroup.

Such diversity poses difficulties for psychological assessment. Clinicians make both Diagnostic and Statistical Manual (DSM) and International Classification of Disease diagnoses based upon a clustering of signs (what the provider sees) and symptoms (what the client reports). The structure and content of these documents were derived from research done among the dominant ethnic and cultural groups within the industrialized Western world. The fit of these systems to patterns of signs and symptoms seen among other cultures and subcultures is not well established.

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