Cultural competence and master therapists: an inextricable relationship.

Striving for cultural competence and developing expertise are both highly desirable objectives in the field of mental health counseling. That the two concepts have been investigated rather independently of each other is surprising. The importance of and rationale for combining two scientific knowledge bases of cultural competence and research about expertise in mental health counseling are the focus of this article. The case for a more deliberate juxtaposing of the two research areas of cultural competence and expertise in mental health counseling is made by highlighting the interrelatedness of cultural competence and master therapist research, the diversity of mental health consumers, the requirements of ethical practice, and the need to reduce bias in how mental health research is conducted.

**********

Skovholt and Jennings (2004) have provided a rich, insightful, and illuminating portrait of master therapists and the development of expertise in mental health counseling that is, I believe, cutting-edge. However, I am recommending that more attention be given toward investigating the role of cultural competence in the research on expertise. In an earlier report of their findings, Jennings and Skovholt (1999) were aptly self-critical about the lack of diversity in the sampling for their landmark study on the cognitive, emotional, and relational characteristics of master therapists. Jennings, Goh, Skovholt, Hanson, and Banerjee-Stevens (2003), in addressing the multiple factors that contribute to the development of expertise in counselors and therapists, also noted that the literature on expertise in mental health counseling fails to give sufficient attention to the role of cultural competence. I understand that the methodology used in the studies mentioned in Skovholt and Jennings' book did not intentionally seek to leave culture out of the equation. Other studies on expertise in counseling similarly did not fully capture or address cultural competence aspects of expertise (e.g., Goldfried, 2001: Goldfried, Raue, & Castonguay, 1998: Orlinsky et al., 1999). Methodological constraints notwithstanding, I believe that more can and needs to be done to address issues of cultural competence in studies of expertise in mental health counseling.

In this article, I will argue the case for a more deliberate juxtaposing of cultural competence with expertise in mental health counseling by outlining the following reasons: (a) Cultural competence and expertise in mental health counseling are conceptually similar and intertwined, (b) counselors and therapists need to be trained to work with the increasing cultural diversity in our communities, (c) developing cultural competence is required for ethical practice, and (d) meaningful research on expertise in mental health counseling must include and involve cultural diversity.

CONCEPTUAL SIMILARITIES BETWEEN CULTURAL COMPETENCE AND MASTER THERAPISTS

Two concepts frequently used in mental health counseling that address cultural expertise are cultural competence and multicultural counseling competence. S. Sue (1998) defined cultural competence as "the belief that people should not only appreciate and recognize other cultural groups but also be able to work effectively with them" (p. 440). The term multicultural counseling competence has been defined as a counselor's beliefs/attitudes, knowledge, and skills that relate to working with culturally diverse clients (D. W. Sue, Arredondo, & McDavis. 1992: D. W. Sue et al., 1998). Another definition describes multicultural counseling as "preparation and practices that integrate multicultural and culture-specific awareness, knowledge and skills into counseling interaction" (Arredondo et al., 1996, p. 43). The most comprehensive definition of cultural competence is perhaps provided by the Substance Abuse and Mental Health Services Administration (1997):

   A set of congruent practice skills, behaviors, attitudes, and
   policies that come together in a system, agency, or among
   professionals and enables that system, agency, or those
   professionals to work effectively in cross-cultural situations. It
   is the ability to demonstrate skills and knowledge which enable a
   person to work effectively across cultures: the ability to provide
   mental health treatment within the cultural framework of the
   consumer: the ability to provide effective services to people of a
   specific cultural background, including one different from the
   provider. (p. 27)

In this article, I use the term cultural competence as also representing multicultural counseling competence. It also should be noted that definitions of culture in these instances often are inclusive of gender, ability/disability, and sexual orientation and deal with a broader diversity than just purely race and ethnicity (D. W. Sue, 2001a).

Jennings and Skovholt (1999) stated that the term master therapist "is used frequently in the mental health lexicon to describe therapists considered to be 'the best of the best' among fellow practitioners" (p. 4). Orlinsky et al. (1999) defined mastery through their perceived mastery scale in a more traditional sense of a master craftsperson. Orlinsky et al. defined therapeutic expertise in terms of knowing "what happens moment-by-moment during therapy sessions ... precision, subtlety, and finesse in therapeutic work ... ability to guide the development of other therapists" (p. 211). Orlinsky (1999) elaborated on potential meanings in the use of the word master that could refer to "one who teaches or someone who practices with exemplary proficiency" (p. 13) and described mastery in practice to be "an encompassing, inventive, procedural kind of knowledge that can be modeled impressively for others or used as a basis for supervisory shaping of the practice of others" (p. 13).

Conceptually, both cultural competence and the more general expertise in counseling and therapy try to capture the essence and characteristics of high functioning counselors in therapeutic situations. Both attempt to describe competencies required to perform well in mental health counseling. In an attempt to differentiate the two concepts, expertise in master therapist research has been called general or traditional competence and the other, multicultural counseling competence. Pedersen (1991) was the first to suggest that all counseling that is effective must be responsive to the cultural nuances present in every counseling relationship. Fuertes, Bartolomeo, and Nichols (2001) believe that multicultural competence goes beyond traditional counseling, but the two are related "because one may need basic competence and even expertise in traditional counseling methods and techniques (such as the use of empathy and paraphrasing skills) to meaningfully engage and use multicultural competencies" (p. 10). Two studies have found general and multicultural competence to be highly correlated (Coleman, 1998: Fuertes & Brobst, 2002). Coleman actually questioned the assumption that general and multicultural counseling competence are separate constructs and suggested that the terms may be inseparable. More recently, it has been argued that multicultural counseling competence is a superordinate (D. W. Sue, 2001b; D. W. Sue & D. Sue, 2003) and higher order (Weaver, 2005) competency to achieve.

Another striking similarity between expertise in counseling and multicultural counseling competency is how difficult it is to arrive at a satisfactory definition of each and how attempts to do so are fraught with challenges. Ridley, Baker, and Hill (2001) concluded that "what remains elusive is a collectively agreed upon operationalization that comprehensively and accurately captures the quintessence of the construct cultural competence" (p. 823). In addition, concerns about how to translate cultural competence theory into training and practice, and consequently how to measure and assess such competencies, have been raised in the literature (e.g., Constantine & Ladany, 2000, 2001: S. Sue, 1999). Orlinsky's (1999) comments and questions in his reaction article to Jennings and Skovholt (1999) echo many definitional difficulties that also are faced in defining master therapists.

The similarities between cultural competence and master therapists further extend to the way in which both concepts are theorized and modeled. For example, in comparing D. W. Sue (2001a) and Skovholt and Jennings (2004), one can observe the following similarities:

1. Capturing the essence of cultural competence and expertise is elusive.

2. Cultural competence and mastery in therapy are complex and multifaceted.

3. Both concepts are described as developmental processes.

4. Both concepts are portrayed as developmental characteristics, and these characteristics can be taught or trained.

5. There is a positive goal orientation for both concepts in the sense that developing each set of characteristics is highly desirable.

6. Multiple diagrams of all shapes, forms, and dimensions--such as cubes, circles, layers, and radial diagrams--have been attempted to portray each concept.

7. Both concepts represent ideal or exemplary role models for maximizing effectiveness in mental health counseling.

8. Both concepts are difficult to operationalize and translate into training goals.

The apparent similarities between cultural competence and expertise, therefore, suggest that we need to do a better job, even with naturalistic or phenomenological research designs, to inquire about the role of and relationship with cultural competence.

CULTURAL COMPETENCE FOR CULTURALLY DIVERSE COMMUNITIES

The rapidly growing diversification of the United States and the changing demographic complexion in many communities (D. W. Sue & D. Sue, 2003) demand a serious review of access and efficacy issues in mental health counseling. What is unclear with many studies on expertise is the ethnic or diversity makeup of the participants who were surveyed or interviewed and whether they reflect society's growing diversity. The surgeon general's report Mental Health: Culture, Race, and Ethnicity (U.S. Department of Health and Human Services, 2001) noted discrepancies in the delivery of mental health services to ethnic minority populations in the United States. Culture, it was concluded, matters in how ethnic minorities fail to access or confront barriers when trying to obtain help. The report found that "major disparities exist in the access, utility and quality of mental health services for racial minorities" (p. 163). Training culturally competent counselors is essential in bridging this gap by making their work more relevant to diverse populations (Pedersen, Draguns, Lonner, & Trimble, 2002; Pope-Davis, Liu, Toporek, & Brittan-Powell, 2001). Even though Orlinsky, Botersman, Ronnestad, and the SPR Collaborative Research Network's (2001) remarkable study of 4,000 participants has strong international representation, the findings do not necessarily translate to ethnic minority mental health issues in the United States.

It is increasingly recognized that cultural factors such as race, gender, sexual orientation, national origin, and ability/disability play some role in the therapist-client relationship and the effectiveness of therapy (Atkinson, Morten, & D. W. Sue, 1998; Pope-Davis et al., 2002; Pope-Davis & Coleman, 1997; Ridley, 1995). Ridley, Baker, and Hill (2001) considered cultural competence to be of critical consideration for all mental health professionals.

S. Sue (1998) noted that it is as yet inconclusive why ethnic minorities do not utilize mental health services in the same manner as Whites. Sue found that at least three critical variables influence cultural competence: (a) ethnic match (i.e., ethnically similar client and therapist); (b) service match (i.e., utilization of ethnic-specific services); and (c) cognitive match (i.e., when clients and therapists think in the same manner). Although ethnic match and ethnic-specific services studies reflect more favorable outcomes for ethnic minority clients, Sue concluded that the reasons why remain unclear. Cognitive match studies, however, reveal that when therapists and clients share conceptions and expectations about the therapeutic process, better outcomes emerge. Sue concluded by describing three culturally competent characteristics that mental health professionals should possess: (a) scientific mindedness, testing hypotheses when uncertain about cultural meanings; (b) the ability to "dynamic-size," a term borrowed from computer science and applied to mental health practice as knowing when to individualize and generalize about clients; and (c) the development of culture-specific expertise. It would be interesting for research on expertise to explore or test Sue's thesis.

Fourteen years ago, Ponterotto and Casas (1991) had already noted an increase in the number of publications that address cultural competence. The continuing interest in training counselors and therapists to be culturally competent is reflected in the burgeoning number of studies that investigate the processes for culturally competent practice. Examples of the increasing emphasis on the training and effect of multicultural counseling competence may be found in special issues of journals, such as the Journal of Mental Health Counseling, 26(1); The Counseling Psychologist, 26(1), 26(4), 29(6), and 30(3); and the Journal of Multicultural Counseling and Development, 29(1). Two other journals, Cultural Diversity and Ethnic Minority Psychology and the Journal of Counseling and Development, are also frequent publishers of articles related to culture and mental health practice.

Even as scientific knowledge grows and our practice evolves to more effectively address the mental health needs of the culturally diverse, it is clear that cultural competence needs to be at the forefront of discussions around expertise in mental health counseling. Training culturally competent counselors to work effectively with the increasing diversity in schools, higher education, the workplace, families, and communities is an urgent need now more than ever (D. W. Sue & D. Sue, 2003). To do any less is unethical (S. Sue, 1998), racist (Ridley, 1995), and cultural malpractice (Hall, 1997).

CULTURAL COMPETENCE FOR ETHICAL PRACTICE

Multicultural counseling competence stands for ethical practice (Arredondo, 2004). The development of cultural competence as ethical practice recently was highlighted when the American Psychological Association (APA, 2002) approved the Guidelines for Multicultural Education and Training, Research, and Practice for Psychologists. The APA Guidelines mirrors the codes of ethics of the American Mental Health Counselors Association (2000) and the American Counseling Association (1995) in emphasizing the need for mental health professionals to understand the diverse backgrounds and cultures of the clients with whom they work. Furthermore, the Council for the Accreditation of Counseling and Related Educational Programs in its Standards (CACREP, 2001) requires that all CACREP-accredited counselor education programs provide students with training and knowledge in working with culturally diverse clients.

Pack-Brown and Williams (2003) in their textbook illustrated with many cases studies and anecdotes how culturally complex situations can pose ethical dilemmas for counselors and therapists. They emphasized both the importance of making ethical decisions within the cultural framework of clients and the critical expectation that supervisors be effective in a multicultural context. In turn, the unique roles that culture and cultural competence play in supervision were addressed at length in an entire section of a book by Pope-Davis and Coleman (1997). Ridley, Liddle, Hill, and Li (2001) argued that ethical decision-making in multicultural counseling situations "requires more critical reflection and creative problem solving than is facilitated by ethical codes" (p. 166).

There is almost verbatim consensus, in every definition of ethical practice by professional mental health associations, that culturally competent practice equals ethical practice. It is therefore incumbent that mental health researchers who study expertise in counseling reflect this basic assumption.

CULTURAL COMPETENCE AND MENTAL HEALTH COUNSELING RESEARCH

S. Sue (1999) put it pointedly:

   I believe that there is a lack of psychological research on ethnic
   minority populations; that research on ethnic minority groups is
   uneven, with much of it at a relatively low level; and that funding
   for ethnic minority research has been woefully inadequate. (p. 1070)

Sue elaborated that an overemphasis on internal validity and a lack of attention to external validity has led to an overgeneralization of findings based on studies that utilize only small subsets of people. S. Sue and L. Sue (2003) believe that conducting ethnic research is good science and good for science.

The APA (2002) Guidelines, mentioned earlier, were based on the premise that the United States is becoming more racially and ethnically diverse. Therefore, scientists who conduct mental health research should reflect that diversity in their research sampling and methodology. Guideline 4 in the APA Guidelines encourages mental health researchers to be culture-centered and ethical when conducting research with ethnic, linguistic, and racial minorities.

Citing Heppner, Kivlighan, and Wampold's (1999) listing of five types of research validity (i.e., internal, external, construct, hypothesis, and statistical conclusion), Quintana, Troyano, and Taylor (2001) suggested that cultural validity be added to the list. The authors defined cultural validity as the following:

   The authentic representation of the cultural nature of the research
   in terms of how constructs are operationalized, participants are
   recruited, hypotheses are formulated, study procedures are adapted,
   responses are analyzed, and results are interpreted for a particular
   cultural group as well as the usefulness of the research for its
   instructional utility in educating readers about the cultural group
   being investigated, its practical utility in yielding practice as
   well as theoretical implications about the cultural group, and its
   service utility in "giving back" to the community in important
   ways. (p. 617)

These authors went on to outline ways in which researchers can maximize cultural validity during various phases of research. Their ideal is best captured in this opening statement: "Someday, we hope, all research will be multicultural and we will not need the qualifier 'multicultural' when referring to research" (p. 604).

Skovholt and Jennings (2004) in their qualitative study utilized a research methodology that is well suited for culture-centered studies. Ponterotto (2002) and Ponterotto, Costa, and Werner-Lin (2002) described qualitative research methods as the fifth force in psychology. Ponterotto and associates noted that qualitative or multimethod approaches are ideal for understanding the complex juxtaposition of culture and mental health counseling and that qualitative methods may be even more effective in tapping the complex interacting forces such as cultural competence and expertise in counseling. S. Sue (1999) noted the need for more qualitative studies to understand old and new constructs from different cultural perspectives. An inductive analysis allows the researcher to understand the data without imposing preexisting expectations on the topic of study within cross-cultural contexts. Marsella (1998) and S. Sue (1999) claimed that cross-cultural research has not been as conclusive or useful because of the bias in value-laden assumptions and hypotheses of previous research methodologies and because of viewing results from Western lenses. S. Sue recommended a variety of research methods for our knowledge about culture's role in mental health counseling to grow substantially. Marsella believes that the increased use of qualitative research methods will expand our boundaries in understanding culture and mental health counseling as well as reduce the way research is viewed predominantly from a Western ethnocentric bias.

At the time of this writing, I am pleased to note that I have secured grant funding to replicate the Jennings and Skovholt (1999) study, in collaboration with the original authors, with a focus on multicultural counseling competence. We hope that deliberate attempts to elicit cultural dimensions in expertise in our research questions and through our interviews will help to shed light on the role and relationship of cultural competence vis-a-vis general expertise in mental health counseling.

CONCLUSION

In this brief article, I have tried to paint, in very broad brush strokes, what I consider to be the essential and obvious reasons why research on expertise in mental health counseling needs to be juxtaposed with its conceptual twin of cultural competence. In doing so, I hope that I have not underrepresented the vast body of knowledge on cultural competence and multicultural counseling nor undermined the bold positive steps that have been taken in master therapist research (Orlinsky et al., 2001: Skovholt & Jennings, 2004). I gave more attention to the two constructs" similarities because I believe the similarity forms the theoretical basis for why the two are inextricably related. I then made the case for their juxtaposition based on the more pragmatic realities of the changing national demographics, clinical and ethical prudence, and, finally, research responsibility.

Research about cultural competence and expertise in mental health counseling continues to grow and will undoubtedly make significant contributions to the scientific knowledge as well as to the training, education, and practice of mental health counseling. Even as I write, I am mindful of the recent work by Earley and Ang (2003) on cultural intelligence and Sternberg's (2004) thinking about culture and intelligence that shed new light on how culture potentially manifests itself in what we consider to be expertise, indeed, cultural competence is very much a vibrant topic that is evolving every day. I am confident, therefore, that when we include it in our study of master therapists, our understanding will be enhanced, and the mental health professions will be the better for it.

REFERENCES

American Counseling Association. (1995). Code of ethics and standards of practice. Alexandria, VA: Author.

American Mental Health Counselors Association. (2000). Code of ethics. Alexandria, VA: Author.

American Psychological Association. (2002). Guidelines for multicultural education and training, research, practice, and organizational change for psychologists. Washington, DC: Author.

Arredondo, P (2004). Multicultural counseling competencies = ethical practice. Journal of Mental Health Counseling, 26, 44-55.

Arredondo, P., Toporek, R., Brown, S. P., Jones, J., Locke, D., Sanchez, J., el al. (1996). Operationalization of the multicultural counseling competencies. Journal of Multicultural Counseling and Development, 24, 42-78.

Atkinson, D. R., Morten, G., & Sue, D. W. (1998). Counseling American minorities. Boston: McGraw-Hill.

Coleman, H. L. K. (1998). General and multicultural counseling competency: Apples and oranges? Journal of Multicultural Counseling and Development, 26, 147-156.

Constantine, M. G., & Ladany, N. (2000). Self report multicultural counseling competence scales and their relation to social desirability and multicultural case conceptualization ability. Journal of Counseling Psychology, 47, 155-164.

Constantine, M. G., & Ladany, N. (2001). New visions for defining and assessing multicultural counseling competence. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd ed., pp. 482-498). Thousand Oaks. CA: Sage.

Council for the Accreditation of Counseling and Related Educational Programs. (2001). The 2001 standards. Alexandria, VA: Author.

Earley, P C., & Ang, S. (2003). Cultural intelligence: Individual interactions across cultures. Palo Alto, CA: Stanford University Press.

Fuertes, J. N., Bartolomeo, M., & Nichols, C. M. (2001). Future research directions in the study of counsellor multicultural competency. Journal of Multicultural Counseling and Development, 29, 3-12.

Fuertes, J. N., & Brobst, K. (2002). Clients' ratings of counselor multicullural competency. Cultural Diversity and Ethnic Minority Psychology, 8, 214-223.

Goldfried, M. R. (Ed.). (2001). How therapists change: Personal and professional reflections. Washington, DC: American Psychological Association.

Goldfried, M. R., Raue, P J., & Castonguay, L. G. (1998). The therapeutic focus in significant sessions of master therapists: A comparison of cognitive-behavioral and psychodynamic-interpersonal interventions. Journal of Consulting and Clinical Psychology, 66, 803-810.

Hall, C. C. I. (1997). Cultural malpractice: The growing obsolescence of psychology. American Psychologist, 52, 642-651.

Heppner, P R, Kivlighan, D. M., & Wampold, B. E. (1999). Research design in counseling (2nd ed.). Belmont, CA: Brooks/Cole.

Jennings, L., Goh, M., Skovholt, T. M., Hanson, M., & Banerjee-Stevens, D. (2003). Multiple factors in the development of expert counselors and therapists. Journal of Career Development, 30, 59-72.

Jennings, L., & Skovholt, T. M. (1999), The cognitive, emotional, and relational characteristics of master therapists. Journal of Counseling Psychology, 46, 3-11.

Marsella, A. (1998). Toward a "global-community psychology": Meeting the needs of a changing world. American Psychologist, 53, 1282-1291.

Orlinsky, D. E. (1999). The master therapist: ideal character or clinical fiction? Comments and questions on Jennings and Skovholt's "'The cognitive, emotional, and relational characteristics of master therapists." Journal of Counseling Psychology, 46, 12-15.

Orlinsky, D.E., Botersman, J., Ronnestad. M. H., and the SPR Collaborative Research Network. (2001). Toward an empirically grounded model of psychotherapy training: Four thousand therapists rate influences on their development. Australian Psychologist, 36, 1-10.

Orlinsky, D. E., R0nnestad, M. H., Ambuehl, H., Willutzki, U., Botersman, J., Cierpka, M., et al. (1999). Psychotherapists assessments of their development at different career levels. Psychotherapy, 36, 203-215.

Pack-Brown, S. R, & Williams, C. B. (2003). Ethics in a multicultural context. Thousand Oaks, CA: Sage.

Pedersen, P. B. (1991). Multiculturalism as a generic approach Io counseling. Journal of Counseling and Development, 70, 6-12.

Pedersen, E B., Draguns, J. G., Lonner, W. J.. & Trimble. J. E. (2002). Counseling across cultures (5th ed.). Thousand Oaks, CA: Sage.

Ponterotto, J. G. (2002). Qualitative research methods: The fifth force in psychology. The Counseling Psychologist. 30, 394-406.

Ponterotto, J. G., & Casas, J. M. (1991). Handbook of racial/ethnic minority counseling research. Springfield, IL: Charles C. Thomas.

Ponterotto, J. G., Costa, C. I., & Werner-Lin, A. (2002). Research perspectives in cross-cultural counseling. In E B. Pedersen, J. G. Draguns, W. J. Lonner, & J. E. Trimble (Eds.), Counseling across cultures (5th ed., pp. 395-420). Thousand Oaks, CA: Sage.

Pope-Davis, D. B.. & Coleman, H. L. K. (Eds.). (1997). Multicultural counseling competencies: Assessment, education and training, and supervision. Thousand Oaks, CA: Sage.

Pope-Davis, D. B., Liu, W. M.. Toporek, R. L., & Brittan-Powell, C. S. (2001)r What's missing from multicultural competency research: Review, introspection, and recommendations. Cultural Diversity and Ethnic Minority Psychology. 7, 121-138.

Pope-Davis, D. B., Toporek, R. L., Ortega-Villalobos, L., Ligiero, D. R, Brittan-Powell, C. S., Liu, W. M., et al. (2002). Client perspectives of multicultural counseling competence: A qualitative examination. The Counseling Psychologist. 30, 355-393.

Quintana, S. M., Troyano. N., & Taylor, G. (2001). Cultural validity and inherent challenges in quantitative methods for multicultural research. In J. G. Ponterotto, J. M. Casas. L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd ed., pp. 604-630). Thousand Oaks, CA: Sage.

Ridley, C R. (1995). Overcoming unintentional racism in counseling and therapy: A practitioner's guide to intentional intervention. Thousand Oaks, CA: Sage.

Ridley, C. R., Baker. D. M.. & Hill, C L. (2001). Critical issues concerning cultural competence. The Counseling Psychologist, 29, 822-832.

Ridley, C. R., Liddle, M. C., Hill, C. L., & Li, L. C. (2001). Ethical decision making in multicultural counseling. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multicultural counseling (2nd ed., pp. 165-188). Thousand Oaks, CA: Sage.

Skovholt, T. M., & Jennings, L. (2004). Master therapists: Exploring expertise in therapy and counseling. Boston: Allyn and Bacon.

Sternberg, R. J. (2004). Culture and intelligence. American Psychologist, 59, 325-338.

Substance Abuse and Mental Health Services Administration. (1997). Cultural competence guidelines in managed care mental health services for Asian and Pacific Islander populations. Boulder, CO: The Western Interstate Commission for Higher Education Mental Health Program, Asian and Pacific Islander American Task Force.

Sue, D. W. (2001a). Multidimensional facets of cultural competence. The Counseling Psychologist, 29, 790-821.

Sue, D. W. (2001b). The superordinate nature of cultural competence. The Counseling Psychologist, 29, 850-857.

Sue, D. W., Arredondo, P, & McDavis, R. J. (1992). Multicultural counseling competencies and standards: A call to the profession. Journal of Counseling and Development, 70, 477-486.

Sue, D. W., Carter, R. T., Casas, J. M., Fouad, N. A., Ivey, A. E., Jensen, M., et al. (1998). Multicultural counseling competencies: Individual and organizational development. Thousand Oaks, CA: Sage.

Sue, D. W., & Sue, D. (2003). Counseling the culturally diverse: Theory and practice (4th ed.). New York: John Wiley & Sons.

Sue, S. (1998). In search of cultural competence in psychotherapy and counseling. American Psychologist, 53, 440-448.

Sue, S. (1999). Science, ethnicity, and bias: Where did we go wrong? American Psychologist, 54, 1070-1077.

Sue, S., & Sue, L. (2003). Ethnic research is good science. In G. Bernal, J. E. Trimble, A. K. Burlew, & F. T. Leong (Eds.), Handbook of racial and ethnic minority psychology. Thousand Oaks, CA: Sage.

U.S. Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicity--A supplement to mental health: A report of the surgeon general. Rockville, MD: Author.

Weaver, H. N. (2005). Explorations in cultural competence: Journeys to the four directions. Belmont, CA: Thomson Brooks/Cole.

The author thanks Ling-Hsuan Tung for her assistance with this article.

Dr. Michael Goh is with the Counseling and Student Personnel Psychology Program, Department of Educational Psychology, University of Minnesota, Minneapolis. E-mail: [e-mail]