The Role of Culture in the Treatment of
Culturally Diverse Populations
Joseph F. Aponte
University of Louisville
The purpose of this chapter is to describe how culture enters into the psychological treatment of ethnically diverse populations. The chapter takes a multicultural approach rather than a cross-cultural perspective, although many of the observations are applicable to other cultures. More specifically, it focuses on four major ethnic groups (African Americans/Blacks, Hispanics/Latinos, Asian Americans and Pacific Islanders, and American Indians/Native Americans), recognizing that there is a rich diversity of other ethnic groups in this country. Although the focus of the chapter is on the treatment process, it is important to discuss two major trends that will have a direct impact on this process: changes in the ethnic profile and changes in the delivery of mental health services in the United States. Both of these changes will have an important impact on mental health services to ethnic clients.
A broad prospective is used in describing the impact of culture on the treatment process. This perspective involves the different pathways to treatment and mental health utilization rates for ethnic populations. These perspectives are integrated using Beutler and Clarkin's (1990) Differential Treatment Selection model as a mechanism for analyzing the cultural influences on the total treatment process. Throughout this discussion, the relationship between what is often labeled as sociocultural moderator variables (Aponte & Barnes, 1995; Aponte & Johnson, 2000; Dana, 1993; Sodowsky, Lai, & Plake, 1991) and acculturation is a pervasive theme. It is through acculturation, and its correlates, that culture manifests itself in the mental health service delivery and treatment process.
This chapter is directed toward mainstream mental health workers and therapists, and the standard psychotherapeutic treatments used by them, whose clients are one or more of the four previously identified ethnic groups. As Wohl (1995, 2000) points out, the mental health profession has not been very successful in recruiting and training ethnic practitioners. The prospects of that changing in the future remain dismal (Aponte & Aponte, 2000; Aponte & Clifford, 1995). Accordingly, White mainstream practitioners will invariably find themselves working with ethnically diverse clients. The discussion thus focuses on developing an appreciation for, and application of, cultural factors in the psychological treatment of ethnic clients.