CONCEPTUALIZATION ABILITY
TRAINEE MULTICULTURAL CASE CONCEPTUALIZATION ABILITY AND COUPLES THERAPY
Allison M. Schomburg University of Akron
Loreto R. Prieto Iowa State University
Previous literature on the assessment of multicultural counseling competence has been concerned only with counselors’ abilities when working with individual clients. We expanded this line of research by investigating trainees’ multicultural case conceptualiza- tion ability in the context of working with couples. Despite the fact that trainees self- reported a high level of multicultural competency, trainees were largely inattentive to racial factors in their case conceptualization responses to vignettes involving both African American and European American clients presenting for couples therapy. On the whole, despite didactic, clinical, and extracurricular training in multiculturalism, marriage and family therapy trainees did not sufficiently incorporate cultural factors into their clinical case conceptualizations. We discuss implications for teaching, practice, and future research.
In the last decade, investigators and educators in marriage and family therapy (MFT) have paid an increased level of attention to multicultural issues. Guidelines for working with diverse families have been produced (Bean, Perry, & Bedell, 2001, 2002), educators have emphasized cultural diversity in the recruitment of students and in curricula (Hardy & Keller, 1991; Sierra, 1997), and MFT researchers have modestly increased diversity-related scholarship (Killian & Hardy, 1998).
However, some observers have noted a continuing lack of minority representation in MFT programs, a lack of primary research interests in multiculturalism among MFT scholars, and a lack of multicultural competency evaluations of trainees as deficits remaining within MFT pro- grams (cf. Inman, 2006). In response to these deficits, some authors have created multicultural training guidelines (cf. Green, 1998). However, the usefulness and validity of proposed models and methods to assess trainee multicultural competencies have been called into question.
In particular, several scholars (e.g., Atkinson & Israel, 2003; Constantine & Ladany, 2001; Vera & Speight, 2003; Weinrach & Thomas, 2002) have criticized the theoretical and practical limitations of the most popular model for assessing multicultural competencies, the Sue and Sue (1999) rubric of multicultural knowledge, skill, and awareness. As well, the self-report instruments used to assess these multicultural competencies have been demonstrated to have poor psychometric qualities (Constantine & Ladany, 2001; D’Andrea, Daniels, & Heck, 1991; Ponterotto, Rieger, Barrett, & Sparks, 1994; Pope-Davis & Dings, 1994, 1995).
Investigators have also argued that socially desirable responding may contaminate the responses on self-report measures of multicultural counseling competence (Constantine &
This manuscript represents a portion of a dissertation completed by Schomburg, under the direction of
Prieto, as a part of the requirements for her doctoral degree at the University of Akron. Allison M. Schomburg
is now a Staff Psychologist at the Creighton University Counseling and Psychological Service, Creighton
University; Loreto R. Prieto is a Professor of Psychology and Director of U.S. Latino ⁄ a Studies at Iowa State University.
We would like to thank Ms. Abby Bjornsen, MA, University of Nebraska-Lincoln, and Ms. Sara
Streedbeck, Southeast Community College, for their assistance with coding data in this study.
Address correspondence to Loreto R. Prieto, PhD, Department of Psychology, Iowa State University, Ames,
Iowa 50011-3180; E-mail: [email protected]
Journal of Marital and Family Therapy doi: 10.1111/j.1752-0606.2009.00156.x April 2011, Vol. 37, No. 2, 223–235
April 2011 JOURNAL OF MARITAL AND FAMILY THERAPY 223
Ladany, 2001). As well, the myriad of instruments designed to measure multicultural compe- tence domains appear to not be measuring similar constructs. Pope-Davis and Dings found that the Awareness subscales of the Multicultural Counseling Inventory (MCI; Sodowsky, Taffe, Gutkin, & Wise, 1994) and the Multicultural Counseling Knowledge and Awareness Scale (MCKAS; Ponterotto, Reiger, Gretchen, Utsey, & Austin, 1999) shared only 10% of their variance. Similarly, Worthington, Mobley, Franks, and Andreas Tan (2000) found the MCI (Sodowsky, et al., 1994) and the Cross-Cultural Counseling Inventory-Revised (CCCI-R; LaFromboise, Coleman, & Hernandez, 1991) to have negative or near zero correlations. These measures have also been uniformly used to assess competence only in individual counseling interactions rather than in interactions with larger client systems as carried out in couple and family therapy (Constantine & Ladany, 2001). Finally, traditional self-report, multicultural competency inventories are likely to measure anticipated rather than actual multicultural coun- seling competence. In other words, these instruments are tapping trainees’ sense of self-efficacy in the future execution of the competencies (Constantine & Ladany, 2000; Pope-Davis & Dings, 1995). Statistically speaking, little relation appears to exist between how trainees view their own sense of multicultural competency and the behaviors they actually demonstrate.
Multicultural Case Conceptualization Ability Because of the shortcomings of traditional methods used to assess multicultural compe-
tency, Constantine and Ladany (2001) developed a behavior-based method of assessment that objectively evaluates trainees’ case conceptualization ability in terms of the incorporation of cli- ents’ cultural variables. Studies using this method have assessed to what degree respondents actually integrate and differentiate multicultural information into the etiology and treatment conceptualizations associated with clients’ presenting concerns (Constantine & Ladany, 2000, 2001; Ladany, Inman, Constantine, and Hofheinz, 1997).
Only one study to date has used the multicultural case conceptualization ability (MCCA) task with a marriage and family focus. Inman (2006) sampled 147 MFT trainees to determine their perceptions of supervisor multicultural competence and their satisfaction with supervision. In part, Inman found a lack of a significant correlation between trainee self-reported and MCCA-based multicultural counseling competence. Interestingly, despite using an MFT trainee sample, the MCCA vignette used by Inman in this study depicted an individual client seeking individual counseling.
Criticisms of the MCCA Method Despite being an advance from previous assessment tools, limitations have been found with
the MCCA method. Bromley (2004) reported that vignettes used in previous MCCA research described a single client who is seeking individual counseling services. In addition, all but one of these six vignettes described only a client of color. All failed to assess whether counselors account for the impact of race for European American clients. Current developments in the domain of multicultural psychology (e.g., White privilege, White racial identity development, color-blind racial attitudes) suggest that trainees also need to appreciate racial factors when working with majority culture clients.
In addition, there is a lack of consensual validation both among traditional self-report mea- sures of multicultural competency as well as between observed and self-reported multicultural competency measures (Constantine & Ladany, 2000; Ladany et al., 1997). This has led to two main questions: Which method is the more ‘‘accurate’’ and ‘‘valid’’ measure of trainees’ compe- tency (e.g., self-report instruments or the MCCA behavioral task), and Why do these two methods of assessing multicultural competency (e.g., self-report instruments or the MCCA behavioral task) have little to no correlation with one another? Finally, past MCCA research has not provided verbatim examples of participants’ written responses so that educators and supervi- sors might have a qualitative sense of what a stronger versus weaker MCCA looks like.
Bromley (2004) advanced the typical use of the MCCA method in previous research by providing two conditions for the race of the client in stimulus vignettes (European American and African American) and using a multidimensional approach to examine the influence of social desirability on MCCA scores. Bromley’s results indicated that trainees tended to ignore
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cultural ⁄ racial variables in the European American client vignette but did attend to these vari- ables in the African American vignette condition. Unexpectedly, multidimensional aspects of socially desirable responding were not related to self-reported multicultural counseling compe- tence or MCCA task scores. Bromley also failed to find a statistically significant correlation between scores trainees obtained on the MCCA task and trainees’ self-reported level of multi- cultural counseling competency. Bromley’s recommendations were that researchers use vignettes containing clients from both majority and minority groups and continue to further clarify the relation between the MCCA and self-reported competency measures.
Purpose and Research Questions The purpose of our study was to advance the scarce research in MFT examining the assess-
ment of multicultural counseling competence in marriage and family trainees, particularly their ability to conceptualize clients from a multicultural perspective. To increase validity over past research, we used an MCCA stimulus vignette that described a couple presenting for treatment rather than an individual presenting for individual counseling. In addition, we utilized vignette conditions with both European and African American couples. As in previous research, we examined the relation between our MCCA task and a self-report measure of multicultural counseling competence (cf. Bromley, 2004). Finally, we examined which method of assessing multicultural counseling competence (MCCA or self-report) was most related to variables that are theoretically expected and empirically shown to contribute to multicultural counseling competence (e.g., course work, clinical experience with racially diverse clients, time spent in supervision discussing multicultural issues).
Our hypotheses for this study were that (a) social desirability will be statistically signifi- cantly positively correlated with both the Knowledge and Awareness subscales of the MCKAS; (b) social desirability will not be statistically significantly positively correlated with trainees’ MCCA scores; (c) the MCKAS will not be statistically significantly correlated with MCCA etiology or treatment scores; (d) main effects for the MCCA vignette race condition will exist, with participants generating statistically significantly higher mean scores on the African American vignette versus European American clients; and (e) multicultural training and clinical experience variables will account for greater variance in MCCA scores when compared with MCKAS scores.
METHOD
Participants This study received the approval of an Institutional Review Board, and all human subjects’
rights were observed. We sampled trainees from both MFT and counseling psychology (CP) pro- grams. The inclusion of CP trainees was carried out for two reasons. First, both training directors and students in American Psychological Association-accredited (APA) CP programs had noted CP students’ extremely high interest in learning about and conducting marital and family counsel- ing (Fitzgerald & Osipow, 1988; Schneider, Watkins, & Gelso, 1988). Second, approximately on