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Center because that Substance Abuse treatment (US). Improving cultural Competence. Rockville (MD): problem Abuse and Mental health and wellness Services management (US); 2014. (Treatment innovation Protocol (TIP) Series, No. 59.)


Zhang Min, a 25-year-old first-generation Chinese woman, was described a counselor by her primary care physician because she reported having actually episodes that depression. The counselor who performed the input interview had received cultivate in social competence and also was mindful of cultural factors in examining Zhang Min. The referral provided that Zhang Min was born in Hong Kong, therefore the therapist supposed her come be doubtful to discuss her problems, offered the prejudices fastened to mental illness and also substance abuse in Chinese culture. During the evaluation, however, the therapist was surprised to uncover that Zhang Min was quite forthcoming. She mentioned absent important deadlines at work and also calling in noble at least once a week, and she listed that she coworkers had actually expressed worry after recognize a bottle of wine in she desk. She admitted the she had actually been drink heavily, i beg your pardon she connected to occupational stress and also recent discord v her irish American spouse.

Further inquiry revealed that Zhang Min"s parents, both Chinese, went to college in England and also sent she to a British college in Hong Kong. She prospered up close to the brothers expatriate community, and also her mommy was a nurse v the british Army. Zhang Min concerned the United states at the period of 8 and grew up in an irish American neighborhood. She proclaimed that she knew much more about Irish culture than around Chinese culture. She felt, v the exception of she physical features, that she was an ext Irish than Chinese—a view accepted by plenty of of her irish American friends. Most guys she had actually dated were ireland Americans, and also she socialized in teams in i m sorry alcohol consumption was not just accepted yet expected.

Zhang Min very first started come drink in high college with her friends. The counselor realized the what she had actually learned about Asian americans was no necessarily applicable to Zhang Min and that expertise of Zhang Min"s entire history was vital to evaluate the influence of culture in she life. The counselor thus arisen treatment strategies more suitable come Zhang Min"s background.


Zhang Min"s situation demonstrates why thoroughly evaluation, consisting of assessment the the client"s sociocultural background, is vital for therapy planning. To provide culturally responsive evaluation and treatment planning, counselors and programs must understand and incorporate relevant social factors right into the procedure while preventing a stereotypical or “one-size-fits-all” approach to treatment. Social responsiveness in planning and also evaluation requires being open minded, questioning the appropriate questions, selecting ideal screening and assessment instruments, and also choosing effective treatment providers and modalities for each client. Moreover, it involves identifying culturally pertinent concerns and issues that should be handle to boost the client"s restore process.

This chapter supplies clinical employee guidance in providing and facilitating culturally responsive interviews, assessments, evaluations, and also treatment planning. Using Sue"s (2001) multidimensional design for developing social competence, this chapter concentrates on clinical and programmatic decision and an abilities that are important in evaluation and also treatment plan processes. The chapter is organized about nine procedures to be integrated by clinicians, supported in clinical supervision, and also endorsed by administrators.

Step 1. Interact Clients

Once clients are in contact with a therapy program, they stand on the far side the a yet-to-be-established therapeutic relationship. That is as much as counselors and other employee members to bridge the gap. Handshakes, face expressions, greetings, and tiny talk are an easy gestures that establish a an initial impression and also begin structure the therapeutic relationship. Including one"s totality being in a greeting—thought, body, attitude, and spirit—is most engaging.

Fifty percent the racially and ethnically diverse clients finish treatment or counseling ~ one visit with a mental wellness practitioner (Sue and Sue 2013e). At the outset that treatment, clients deserve to feel scared, vulnerable, and also uncertain around whether therapy will yes, really help. The initial meeting is often the first encounter clients have actually with the treatment system, so it is crucial that they leave emotion hopeful and also understood. Paniagua (1998) defines how, if a counselor lacks sensitivity and jumps to premature birth conclusions, the very first visit can end up being the last:

Pretend the you space a Puerto Rican taxi driver in brand-new York City, and also at 3:00 p.m. Top top a hot summer job you realize the you have actually your first appointment with the therapist…later, friend learned that the therapist made a note that friend were most likely depressed or psychotic due to the fact that you pull carelessly and had dirty nails and hands…would girlfriend return for a second appointment? (p. 120)

To interact the client, the counselor should shot to create rapport prior to launching right into a collection of questions. Paniagua (1998) argues that counselors should draw attention come the presenting problem “without offering the impression that also much information is necessary to recognize the problem” (p. 18). That is additionally important that the client feel engaged with any interpreter supplied in the intake process. A typical framework used in plenty of healthcare training programs to to mark culturally responsive interview behaviors is the find out model (Berlin and also Fowkes 1983). The how-to box on the following page presents this model.

Improving Cross-Cultural Communication

Health disparities have actually multiple causes. One details influence is cross-cultural communication between the counselor and also the client. Weiss (2007) recommends this six steps to improve communication with clients:

Step 2. Familiarize Clients and also Their households With Treatment and Evaluation Processes

Behavioral wellness treatment infrastructure maintain your own society (i.e., the treatment milieu). Counselors, clinical supervisors, and agency administrators deserve to easily become accustomed to this culture and assume the clients are used to it as well. However, clients are typically brand-new to therapy language or jargon, program expectations and also schedules, and also the intake and treatment process. Unfortunately, client from varied racial and ethnic teams can feel more estranged and disconnected from treatment services when staff members fail to education them and also their families about treatment expectations or once the clients space not walked through the therapy process, starting with the objectives of the early intake and also interview. By taking the moment to acclimate clients and also their family members to the therapy process, counselors and other behavioral health staff members handle one obstacle that might further impede treatment engagement and also retention among racially and also ethnically diverse clients.

How To use the discover Mnemonic for Intake Interviews

Listen come each customer from his or her cultural perspective. Avoid interrupting or posing questions prior to the customer finishes talking; instead, find creative ways come redirect dialog (or describe session constraints if time is short). Take it time to discover the client"s perception of his or she problems, concerns about presenting problems and treatment, and preferences for treatment and healing practices.

Explain the overall purpose of the interview and intake process. Walk v the basic agenda because that the initial session and also discuss the reasons for asking about an individual information. Remember that the client"s demands come before the set agenda for the interview; don"t sheathe every intake question at the cost of taking time (usually brief) to deal with questions and also concerns expressed by the client.

Acknowledge customer concerns and discuss the probable differences between you and also your clients. Take time to know each client"s explanatory version of illness and health. Recognize, when appropriate, the client"s heal beliefs and also practices and also explore ways to incorporate these right into the treatment plan.

Recommend a food of activity through teamwork with the client. The customer must understand the importance of his or her participation in the treatment planning process. With customer assistance, customer beliefs and traditions have the right to serve as a framework for heal in treatment. However, no all clients have the very same expectations of treatment involvement; some watch the counselor together the expert, desire a directive approach, and also have little desire to take part in occurring the treatment setup themselves.

Negotiate a treatment plan that weaves the client"s social norms and also lifeways right into treatment goals, objectives, and steps. As soon as the treatment plan and modality room established and also implemented, encourage consistent dialog to acquire feedback and also assess treatment satisfaction. Respecting the client"s society and encouraging communication throughout the procedure increases customer willing to engage in treatment and also to adhere come the treatment plan and continuing care recommendations.

Sources: Berlin and also Fowkes 1983; Dreachslin et al. 2013; Ring 2008.

Step 3. Endorse participation in Interviews, Assessments, and Treatment Planning

Most clients space unfamiliar through the evaluation and treatment planning procedure and exactly how they have the right to participate in it. Some clients might view the early interview and also evaluation as intrusive if too much details is asked for or if the contents is a source of family members dishonor or shame. Other clients might resist or distrust the process based on a long background of racism and also oppression. Still others feeling inhibited from proactively participating because they view the counselor together the government or sole expert.

The counselor can aid decrease the influence of these problems in the interview process through a collaborative technique that permits time to discuss the expectations of both counselor and also client; to explain interview, intake, and also treatment to plan processes; and to develop ways because that the customer to seek clarification that his or she assessment results (Mohatt et al. 2008a). The counselor have the right to encourage cooperation by emphasizing the prestige of clients" input and interpretations. Client feedback is integral in interpreting results and can identify social issues that may affect intake and also evaluation (Acevedo-Polakovich et al. 2007). Participation should expand to customer preferences and desires concerning inclusion the family and community members in evaluation and treatment planning.

Step 4. Incorporate Culturally appropriate Information and Themes

By exploring culturally pertinent themes, counselors have the right to more totally understand their clients and also identify their cultural strengths and challenges. For example, a korean woman"s household may offer as a resource of support and provide a feeling of identity. In ~ the exact same time, however, she family could be ashamed of she co-occurring generalised anxiety and substance use disorders and also respond to her therapy as a source of further shame because it motivates her come disclose personal matters to human being outside the family. The complying with section provides a short overview of argued strength-based topics come incorporate into the intake and evaluation process.

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Advice to Counselors: asking About culture and Acculturation

A thoughtful exploration of social and country identity problems will provide clues for determining cultural, racial, and ethnic identity. There room numerous hints that you may derive from her clients" answers, and also they cannot all be spanned in this TIP; this is only one set of sample concerns (Fontes 2008). Questioning these questions tactfully for this reason they do not sound like an interrogation. Shot to combine them naturally into a conversation rather than questioning one ~ another. No all concerns are appropriate in every settings. Counselors deserve to adapt wording to fit clients" social contexts and styles of communication, due to the fact that the questions listed here and also throughout this chapter are only examples:

Immigration History

Immigration history can shed light on client support systems and also identify feasible isolation or alienation. Part immigrants that live in country enclaves have numerous sources of social support and also resources. Through contrast, others may be isolated, life apart from family, friends, and the assistance systems extant in their nations of origin. Culturally competent testimonial should constantly include questions about the client"s nation of origin, immigration status, length of time in the unified States, and also connections to his or her country of origin. Ask American-born clients about their parents" nation of origin, the language(s) spoken at home, and affiliation with their parents" culture(s). Questions favor these provide the counselor essential clues about the client"s level of acculturation in early life and at present, social identity, ties to society of origin, potential cultural conflicts, and resources. Specific questions must elicit info about:

Length the time in the unified States, noting once immigration developed or the variety of generations who have actually resided in the united States.