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Adapting psychotherapy to the individual patient: Culture.
Smith T.B., Domenech Rodríguez M., Bernal G.
Journal of Clinical Psychology: 2011, 67(2), p. 166–175.
Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr Smith at tbs@byu.edu.
Meta-analytic review commissioned by a US task force concludes that mental health services targeted to a specific cultural group were several times more effective than those for clients from a variety of backgrounds, and that more effective treatments had more cultural adaptations.
Summary This article summarizes definitions, means, and research related to adapting psychotherapy to clients' cultural backgrounds. We begin by reviewing the prevailing definitions of cultural adaptation and providing a clinical example. We present an original meta-analysis of 65 experimental and quasi-experimental studies involving 8620 participants. Substance abuse treatments or prevention programmes were excluded unless they also targeted psychological variables such as depression or self-concept. The omnibus effect size A standard way of expressing the magnitude of a difference (eg, between outcomes in control and experimental groups) applicable to most quantitative data. Enables different measures taken in different studies to be compared or (in meta-analyses) combined. Based on expressing the difference in the average outcomes between control and experimental groups as a proportion of the variability in the outcome across both groups. The most common statistic used to quantify this difference is called Cohen's d. Conventionally this is considered to indicate a small effect when no greater than 0.2, a medium effect when around 0.5, and a large effect when at least 0.8. of 0.46 indicates that treatments specifically adapted for clients of colour were moderately more effective with that clientele than traditional treatments. The most effective treatments tended to be those with greater numbers of cultural adaptations. Mental health services targeted to a specific cultural group were several times more effective than those provided to clients from a variety of cultural backgrounds. We recommend a series of research-supported therapeutic practices that account for clients' culture. Among these are that clients will tend to benefit when psychotherapists try to align treatment with clients' cultural backgrounds. This seems particularly the case for Asian-American clients and adult clients, who the research showed tended to benefit most from culturally adapted treatments relative to other client groups.
commentary This article was in a special issue of the Journal of Clinical Psychology devoted to adapting psychotherapy to the individual patient. For other Findings entries from this issue see:
What works for whom: tailoring psychotherapy to the person
Adapting psychotherapy to the individual patient: Stages of change
Adapting psychotherapy to the individual patient: Preferences
Adapting psychotherapy to the individual patient: Coping style
Adapting psychotherapy to the individual patient: Resistance/reactance level
Adapting psychotherapy to the individual patient: Expectations
Adapting psychotherapy to the individual patient: Attachment style
Adapting psychotherapy to the individual patient: Religion and spirituality
Last revised 09 March 2011
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