Multicultural training, theoretical orientation, empathy, and multicultural case conceptualization ability in counselors.

This study explored the contributions of previous multicultural counseling training, counselor theoretical orientation, and cognitive and affective empathy attitudes in predicting counselors' ability to conceptualize clients' mental health issues from a multicultural perspective. Results revealed that counselors who (a) reported higher levels of formal multicultural training, (b) had an eclectic/integrative theoretical orientation to counseling, and (c) endorsed higher affective empathy attitudes were rated as being better able to conceptualize a culturally diverse client's mental health issues. Future research directions are discussed.

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Attention to issues of multicultural counseling competence has been a primary focus in the field of counseling over the past decade (e.g., Pedersen, 1991; Ponterotto, 1998; Ridley, Mendoza, & Kanitz, 1994; Sue, Ivey, & Pedersen, 1996). Multicultural counseling competence is commonly referred to as counselors' attitudes/beliefs, knowledge, and skills in working with culturally diverse (e.g., racial, ethnic, gender, social class, sexual orientation, etc.) individuals (Sue, Arredondo, & McDavis, 1992; Sue et al., 1998). In recent years, self-reported multicultural counseling competence has been examined in relation to a host of variables, especially demographic, educational, and training variables (e.g., Ottavi, Pope-Davis, & Dings, 1994; Pope-Davis, Reynolds, Dings, & Nielson, 1995; Pope-Davis, Reynolds, Dings, & Ottavi, 1994; Sodowsky, Kuo-Jackson, Richardson, & Corey, 1998).

In particular, the relationship between formal multicultural training and self-perceived multicultural counseling competence has been an area of interest in several previous investigations (e.g., Constantine, Juby, & Liang, 2001; Ottavi et al., 1994; Pope-Davis et al., 1995; Pope-Davis et al., 1994; Sodowsky, Taffe, Gutkin, & Wise, 1994). In nearly all of these studies, prior multicultural training was significantly correlated with higher levels of self-reported multicultural counseling competence. Moreover, some researchers (e.g., D'Andrea, Daniels, & Heck, 1991; Neville et al., 1996) have found that coursework in multicultural counseling contributed to changes in counselors' self-reported competence in working with culturally diverse clients. Taking multicultural coursework has also been linked to increases in counselors' White racial consciousness (e.g., Parker, Moore, & Neimeyer, 1998), White racial identity attitudes (e.g., Neville et al., 1996), and interracial comfort (e.g., Parker et al., 1998). Despite the growing literature in the area of multicultural counseling competence, little information is available regarding the role of previous multicultural training in assessing counselors' demonstrated ability to work with culturally diverse clients.

One aspect of counselors' multicultural competence may be their ability to conceptualize clients' concerns by differentiating and integrating multicultural knowledge pertaining to clients' problems (Ladany, Inman, Constantine, & Hofheinz, 1997). Conceptualizing clients from a multicultural perspective means that counselors are (a) aware of and can integrate the impact of various cultural factors on clients' presenting issues and (b) able to articulate an appropriate treatment plan for working with clients based on this knowledge (Constantine & Ladany, 2000). Client conceptualizations become more complex as counselors make associations between and among hypothesized etiologies of presenting issues and, subsequently, integrate these data into their treatment plans. Hence, counselors' multicultural case conceptualization ability (i.e., the inclusion of cultural data within conceptualizations of clients' presenting concerns) may represent an appropriate manifestation of their actual multicultural counseling competence.

There is a need for research examining factors that may contribute to counselors' ability to conceptualize clients from a multicultural perspective. Specifically, exploring the association between previous multicultural counseling training and multicultural case conceptualization ability may provide important information about the impact of such training in preparing counselors to serve culturally diverse clients. Thus, this study, in part, examined the extent to which prior multicultural training was elated to counselors' multicultural case conceptualization ability.

Another mechanism that may influence counselors' conceptualizations of clients' concerns is their theoretical orientation. In particular, counselors' theoretical orientation may impact the ways in which they make sense of mental health issues affecting culturally diverse individuals. A broad array of counseling theoretical orientations has been presented in the literature over the course of the 20th Century, including psychodynamic, humanistic, and cognitive-behavioral theories. Many of these orientations, however, have been criticized for failing to consider the unique cultural issues associated with diverse groups of clients (Nystul, 1999). In response to some of these criticisms, some counselors have attempted to integrate or blend various types of counseling theories and approaches into their work with clients (Norcross & Newman, 1992). Similarly, eclectic counseling approaches have been increasingly popular in that eclectic counselors generally utilize a primary theoretical orientation, but may borrow techniques from other theoretical orientations based on their proven efficacy (Lazarus & Beutler, 1993). However, little empirical information exists that examines the degree to which certain types of theoretical orientations may be related to counselors' ability to consider multicultural issues in conceptualizing their clients' mental health concerns. Thus, this investigation also explored the extent to which counselors' theoretical orientation was predictive of their multicultural case conceptualization ability.

Of additional interest in this study was the degree to which specific attitudinal variables may predict counselors' ability to conceptualize clients from a multicultural perspective. In particular, it is possible that counselors who possess certain types of empathy attitudes may be able to understand salient cultural issues of diverse clients and, subsequently, be able to apply this understanding to their work with clients. Empathy has been noted as counselors' ability to communicate a sense of caring and understanding regarding clients' experiences (Egan, 1994; Nystul, 1999). In the counseling and psychological literature, empathy has been broadly conceptualized into two categories: cognitive empathy and affective empathy (Davis, 1983). Cognitive empathy refers to one's ability to intellectually assume the perspective of another individual, whereas affective empathy refers to responding to another person's emotions with the same emotion (Day & Chambers, 1991).

The degree to which counselors can appropriately empathize with the concerns of culturally diverse clients may ultimately determine their ability to respond to these clients in a culturally sensitive manner. Ridley and Lingle (1996) conceptualized cultural empathy as counselors' ability to understand the experiences of diverse clients based on counselors' interpretations of cultural data. With regard to culturally diverse clients, counselors' ability to effectively comprehend and respond to these individuals' racial and ethnic group memberships may be critical in alleviating their presenting concerns (Fischer, Jome, & Atkinson, 1998). In this vein, counselors who possess cultural empathy may demonstrate multicultural competence in the context of counseling relationships. Hence, the present study also examined the degree to which certain types of empathy attitudes (i.e., affective and cognitive empathy) were related to counselors' ability to conceptualize clients from a multicultural perspective,

In sum, this investigation examined the role of previous multicultural counseling training, counselor theoretical orientation, and cognitive and affective empathy in predicting counselors' multicultural case conceptualization ability. One main research hypothesis guided this study. Specifically, it was hypothesized that prior multicultural training, theoretical orientation, and cognitive and affective empathy attitudes would account for significant amounts of the variance in counselors' multicultural case conceptualization ability.

METHOD

Participants and Procedure

Potential respondents were randomly selected from a mailing list of members of the American Counseling Association. Of the 200 survey packets mailed, 132 were completed and returned (66% response rate). However, because two of the respondents did not have professional counseling experience, they were excluded from participation by the researcher. No follow-up or reminder letters were sent to potential participants.

Because of missing data or rounding, some percentages do not equal 100. The 83 (63.8%) women and 45 (34.6%) men who responded to the study ranged in age from 23 to 77 years (M = 42.79 years, SD = 13.53), and their racial and ethnic composition was as follows: 100 (76.9%) White Americans, 11 (8.5%) African Americans, 8 (6.2%) Asian Americans, 8 (6.2%) Latino(a) Americans, 2 (1.5%) biracial individuals, and 1 (.8%) American Indian. With regard to their highest educational degree, the participants were comprised of 14 (10.8%) doctoral-level counselors, 90 (69.2%) master's-level counselors, and 26 (20.0%) bachelor's-level counselors. They reported a mean of 12.49 years of counseling experience (SD = 10.35; range = 1 to 40 years). By theoretical orientation, 55 (41.7%) of the participants were categorized as humanistic, 28 (21.5%) as eclectic/integrative, 26 (20.0%) as psychodynamic, and 21 (16.2%) as cognitive-behavioral.

Participants were asked to complete a survey packet consisting of (a) a brief demographic questionnaire, (b) the Perspective-Taking and Empathic Concern subscales of the Interpersonal Reactivity Index (Davis, 1980), and (c) the multicultural case conceptualization ability exercises. The scales and demographic questionnaire were placed after the case conceptualization exercises so as not to influence participants' responses to the case vignette.

For the multicultural case conceptualization exercises, respondents were asked to imagine that they were the counselor for a client whom they were about to meet. Participants were provided with an intake scenario in which the client--who was described as a 32-year-old, gay, Native American male stockbroker--was seeking counseling services at a local mental health clinic. The vignette indicated the client's (a) intense involvement in the traditional rituals of his ethnic group and social advocacy for gay men's rights; (b) current stressors regarding his work situation (e.g., making compromising work decisions that placed his company in financial jeopardy); (c) romantic relationship concerns (e.g., experiencing pressure from his partner to live together as a couple); (d) anxiety about `coming out' to his parents who wish to have grandchildren to "carry on the family name" (the client is an only child); and (e) recreational drug use as a result of the aforementioned issues. Thus, there were several potential cultural and psychological issues that could be pertinent to the formulation of a treatment plan. After reading the vignette, participants were instructed to (a) write a conceptualization of at least three sentences describing what they believed to be the etiology of the client's psychological difficulties, and (b) write a conceptualization of at least three sentences delineating what they believed to be effective treatment strategies or foci for addressing the client's mental health difficulties.

Instrumentation

Demographic questionnaire. Participants were asked to indicate their race or ethnicity, sex, age, highest degree earned, primary theoretical orientation to counseling, and total number of months of professional counseling experience. They were also asked to report the number of formal academic courses they had taken previously related to multicultural or cross-cultural counseling issues. Respondents who indicated more than one primary theoretical approach to counseling were coded as eclectic/integrative.

Interpersonal Reactivity Index (IRI). The IRI (Davis, 1980) is a 28-item, 5-point (0 = does not describe me well, 4 = describes me very well) self-report measure of empathy. It is comprised of four subscales that assess several aspects of empathy. The Perspective-Taking subscale assesses individuals' dispositional tendency to consider others' points of view; the Fantasy subscale measures respondents' propensity to transpose themselves into the feelings and behaviors of fictional characters in movies, books, and plays; the Empathic Concern subscale assesses respondents' feelings of concern, warmth, and sympathy towards others; and the Personal Distress subscale measures feelings of personal discomfort and unease when exposed to others' distress (Davis, 1980; Davis, Luce, & Kraus, 1994). Each subscale consists of 7 items, with subscale scores ranging from 0 to 28. Sex differences are reported to exist for each subscale, with women tending to score higher than men on each subscale (Davis, 1980).

Several investigations have provided evidence of construct validity for the IRI's subscales (e.g., Bernstein & Davis, 1982; Carey, Fox, & Spraggins, 1988; Davis, 1983). The IRI subscales have been reported to have satisfactory internal reliabilities (range = .71 to .77) and test-retest reliabilities (range = .62 to .80) (Davis, 1980). To assess cognitive and effective empathy, respectively, only the Perspective-Taking and Empathic Concern subscales were used in the present study. For the present sample, a Cronbach's alpha of .63 was computed for the Perspective-Taking subscale and a Cronbach's alpha of .72 was calculated for the Empathic Concern subscale.

Multicultural case conceptualization ability. To assess multicultural case conceptualization ability, a coding system was developed by which raters indicated the extent to which participants had integrated salient cultural (i.e., racial/ethnic, gender, and sexual orientation) issues into two conceptualizations of a client's presenting concerns. The coding system designed to measure multicultural case conceptualization ability was based on similar coding systems for assessing integrative complexity (e.g., Tetlock & Suedfeld, 1988) and has been used in previous studies (e.g., Constantine & Ladany, 2000; Ladany et al., 1997). The first conceptualization was based on participants' beliefs about the factors contributing to the etiology of the client's difficulties, and the second one was based on their beliefs about what would be an effective treatment focus or plan for addressing the client's problems. Thus, multicultural case conceptualization ability was operationalized as the extent to which the participants identified and integrated cultural factors into conceptualizations of the etiology and treatment of a client's presenting concerns.

In the current investigation, multicultural case conceptualization ability was measured by examining two interrelated cognitive processes that yielded two separate conceptualization scores. The first process, differentiation, is defined as a counselor's ability to offer alternative interpretations of a client's presenting problems and the nature of the treatment that could be provided. The greater the number of options presented in relation to a client's problems, the greater the degree of differentiation. The second process, integration, is characterized by a counselor's ability to develop associations between and among differentiated interpretations. In numerous prior studies, integrative complexity coding systems have been validated (e.g., Streufert & Streufert, 1978; Tetlock, 1986; Tetlock, Hannum, & Micheletti, 1984) and are reported to have high interrater agreement (e.g., .87; Tetlock & Kim, 1987). More recently, Ladany et al. (1997) reported interrater agreement coefficients of .86 and .87 for the etiology and treatment multicultural case conceptualizations, respectively. In addition, Constantine and Ladany (2000) reported interrater agreement ratings of .93 and .82 for the etiology and treatment multicultural case conceptualizations, respectively.

The raters, two master's-degreed counselors who were trained for 12 hours in the coding of multicultural case conceptualization ability, were not aware of the research hypothesis and coded all of the open-ended etiology and treatment responses for multicultural case conceptualization ability. Multicultural conceptualization scores for each case conceptualization exercise ranged from 0 to 6 as follows:

* 0 = no differentiation, no integration, i.e., no indication of cultural issues in conceptualizing the client's problems

* 1 = low differentiation, no integration, i.e., one reference to cultural issues in conceptualizing the client's problems

* 2 = low differentiation, low integration, i.e., two references to cultural issues in the conceptualization of the client's problems, with one connection made between the two differentiated concepts

* 3 = moderate differentiation, low integration, i.e., three references to cultural issues in the conceptualization of the client's problems, with one connection made between the three differentiated concepts

* 4 = moderate differentiation, moderate integration, i.e., four references to cultural issues in the conceptualization of the client's problems, with two connections made between the differentiated concepts

* 5 = high differentiation, moderate integration, i.e., five references to cultural issues in the conceptualization of the client's problems, with three connections made between the differentiated concepts

* 6 = high differentiation, high integration, i.e., six or more references to cultural issues in conceptualizing the client's problems, with three or more connections made between differentiated concepts

In the present study, Cohen's k coefficients for the etiology and treatment ratings were .88 and .85, respectively.

RESULTS

Table 1 presents the means, standard deviations, and intercorrelations of the study's variables. A series of multivariate analyses of variance was conducted (p = .05) to determine whether participants differed significantly by race or ethnicity, sex, and highest educational degree regarding the etiology and treatment conceptualization indices. No significant interaction or main effect differences were found, so none of these demographic variables was included in the main analyses.

Two hierarchical multiple regression analyses were conducted using the etiology and treatment multicultural case conceptualization indices as the criterion variables. The number of formal multicultural counseling courses taken was entered into the first step of each equation. In the second step, theoretical orientation was entered, for which the four groups (i.e., eclectic/integrative, humanistic, psychodynamic, and cognitive-behavioral) were entered simultaneously with three dummy codes. The eclectic/integrative theoretical orientation was always coded as zero, serving as the constant. The Perspective-Taking and Empathic Concern sub-scales of the IRI were entered together into the third step, serving as measures of cognitive and affective empathy attitudes, respectively.

Table 2 provides a summary of the regression analyses for variables predicting the etiology and treatment multicultural case conceptualization ratings. In the first equation, with etiology conceptualization scores serving as the criterion variable, greater multicultural counseling training was associated with higher etiology case conceptualization scores, F(1, 128) = 12.90, p < .001, [R.sup.2] = .09 (adjusted [R.sup.2] .08). After controlling for the variance accounted for by prior multicultural training, theoretical orientation made additional significant contributions to etiology multicultural case conceptualization ratings, [R.sup.2] change = .17, F(4, 125) change = 9.46, p < .001, [R.sup.2] = .26 (adjusted [R.sup.2] = .24). Specifically, counselors with an eclectic/integrative orientation were rated as having significantly higher etiology case conceptualization skills than did counselors with a psycho-dynamic or cognitive-behavioral theoretical orientation. After accounting for the previous variables, cognitive and affective empathy attitudes in consort added significant variance to the etiology ratings, [R.sup.2] change = .11, F(6, 123) change = 11.24, p < .001, [R.sup.2] = .37 (adjusted [R.sup.2] = .34), with only affective empathy attitudes making a unique positive contribution. The entire regression model, consisting of previous multicultural counseling training, theoretical orientation, and cognitive and affective empathy attitudes, accounted for 37% of the variance in etiology multicultural case conceptualization scores.

The treatment multicultural case conceptualization ratings served as the criterion variable in the second hierarchical multiple regression analysis. In the first step, prior multicultural counseling training was significantly positively predictive of treatment case conceptualization ratings, F(1,128) = 4.26, p < .05, [R.sup.2] = .03 (adjusted [R.sup.2] = .02). After controlling for previous multicultural counseling training, theoretical orientation added significant variance to treatment multicultural case conceptualization ratings, [R.sup.2] change = .08, F(4, 125) change = 3.58,p < .05, [R.sup.2] = .11 (adjusted [R.sup.2] = .08). In particular, counselors with an eclectic/integrative theoretical orientation were rated as having significantly higher treatment multicultural case conceptualization abilities than did counselors with a psychodynamic theoretical orientation. After accounting for the prior variables, cognitive and affective empathy attitudes, both together and individually, contributed significant positive variance to the treatment ratings, [R.sup.2] change = .18, F(6, 123) change = 15.80, p < .001, [R.sup.2] = .29 (adjusted [R.sup.2] = .26). The full regression model, consisting of previous multicultural counseling training, theoretical orientation, and cognitive and affective empathy attitudes, contributed to 29% of the variance in treatment multicultural case conceptualization ratings.

DISCUSSION

This study investigated the contributions of prior multicultural counseling training, counselor theoretical orientation, and cognitive and affective empathy in predicting aspects of multicultural case conceptualization ability in professional counselors. Findings indicated that the number of previous multicultural courses taken was significantly positively related to counselors' ability to conceptualize etiology and treatment issues related to a multicultural client. These results lend support to prior investigations that noted the impact of multicultural counseling training in increasing counselors' self-perceived multicultural competence. For example, D'Andrea et al. (1991) found that counselor trainees' self-perceived multicultural awareness, knowledge, and skills increased significantly following their participation in various types of multicultural counseling training activities. Moreover, Neville et al. (1996) reported that the completion of a multicultural counseling course increased trainees' self-perceived multicultural competence, and these increases were found to remain stable at a 1-year follow-up point. Steward, Morales, Bartell, Miller, and Weeks (1998), however, warned that students' completion of multicultural counseling coursework might not necessarily indicate an automatic embracing of multiculturalism. Nonetheless, the present study's findings suggest that prior academic training in multicultural issues may help counselors to better conceptualize the presenting issues of multicultural clients, and these conceptualizations may parallel, or perhaps contribute to, their ability to work effectively with diverse client populations.

After controlling for the variance accounted for by previous multicultural training, results revealed that counselors with an eclectic/integrative theoretical orientation were rated as having significantly higher etiology multicultural case conceptualization skills than were counselors with a psychodynamic or cognitive-behavioral orientation. Furthermore, counselors with an eclectic/integrative theoretical orientation were found to have greater treatment case conceptualization skills than were counselors with a psychodynamic theoretical orientation. A potential implication of these findings is that counselors' flexibility in utilizing perspectives and techniques from various counseling theories may be beneficial to them in working with culturally diverse clients. The findings may also suggest that although there may be benefits to using a primary theory of counseling (e.g., consistency in treatment conceptualizations and approaches), it is unlikely that any one counseling theory could effectively capture the mental health experiences and issues of all clients (Constantine, 2001; Nystul, 1999).

After accounting for the variance in previous multicultural training and counselor theoretical orientation, cognitive and affective empathy attitudes together made significant contributions to both etiology and treatment multicultural case conceptualization ratings. In particular, affective empathy attitudes contributed significant positive variance to both etiology and treatment ratings of multicultural case conceptualization ability, while cognitive empathy attitudes contributed unique positive variance only to the treatment ratings. Constantine (2000) reported that affective empathy attitudes were positively correlated with self-perceived multicultural counseling competence. The current study's results suggest that counselors who view themselves as equipped to respond affectively to others may be more aware of cultural issues in the context of conceptualizing clients' mental health concerns. Moreover, counselors who are capable of considering others' perspectives or points of view (i.e., have cognitive empathy) may be similarly proficient in conceptualizing treatment issues related to working with culturally diverse clients. In general, counselors' ability to communicate empathy and concern to clients has been identified as a primary precursor to positive client changes (Strupp & Hadley, 1979). Thus, counselors' ability to respond to culturally diverse clients in ways that consider their cultural identities and experiences (i.e., cultural empathy) may contribute to their satisfaction with treatment. A potential implication of these findings for counselor training programs is that academic and applied programs may wish to consider the role of empathy in the development of students' multicultural counseling competence. Specifically, training programs may wish to consider indirectly facilitating students' multicultural counseling competence by identifying strategies to develop or augment their levels of empathy with culturally diverse clients.

The results of this investigation should be considered in the context of several potential limitations. First, caution should be used in generalizing the study's findings because the respondents who returned completed survey packets may have had a particular interest in the study's topic and may differ from individuals who did not respond. A second limitation may be that the study's analog design does not translate directly to clinical practice. In particular, conceptualizing potential etiology and treatment issues in relation to an actual client (instead of a case vignette) may have prompted respondents to have different, and perhaps better and more elaborate, multicultural case conceptualizations. Third, the assessment of multicultural case conceptualization ability was based solely on one vignette at one point in time. It is possible that having participants respond to multiple case conceptualization exercises across various occasions would have resulted in different determinations of their ability to conceptualize clients from a multicultural perspective. A fourth possible limitation is that the relatively small numbers of counselors in some racial and ethnic groups and in some educational degree categories may have decreased the power of some analyses to detect statistical significance. Thus, future studies should examine similar variables in a more racially, ethnically, and educationally diverse sample of counselors. A fifth potential limitation is that although participants reported adhering to a primary theoretical orientation to counseling, their preference for a particular orientation may not be synonymous with their actual work with clients. Sixth, because the empathy measures used in the study were self-report in nature, the participants may not have endorsed their true attitudes or behaviors. Seventh, because only two of the four IRI subscales were included in the questionnaire packet, it is possible that the use of only these subscales affected their validity and reliability. In a related issue, the study's findings may be hampered by the moderate internal consistency coefficients of the IRI subscales.

CONCLUSIONS

The study's results highlight the importance of having multicultural counseling training in academic programs. Hence, future investigations should explore the efficacy of specific multicultural training activities on the development of counselors' multicultural competence. There is also a need for research that specifically examines how theoretical orientation may affect the ways in which counselors work with a range of diverse cultural groups. Moreover, research is needed that identifies other constructs that may be correlates of multicultural counseling competence (e.g., perceived counselor expertness, attractiveness, and trustworthiness). In addition, because counselors' ability to conceptualize clients from a multicultural perspective may be limited to the general level at which they are able to integrate client information, future investigators may wish to explore the extent to which multicultural case conceptualization ability is similar to, or distinct from, general case conceptualization ability (Ladany et al., 1997).

Table 1. Means, Standard Deviations, and Intercorrelations of the
Study's Variables

Variables                                              M        SD

1. Previous Multicultural Courses Taken               1.37     .95

Interpersonal Reactivity Index (IRI; Davis, 1980)
2. IRI Perspective-Taking Subscale                   18.68    3.57
3. IRI Empathic Concern Subscale                     22.31    3.26

Multicultural Case Conceptualization Ability
4. Etiology                                           3.02    1.40
5. Treatment                                          2.12    1.32

Variables                                            1     2

1. Previous Multicultural Courses Taken              --    .23 **

Interpersonal Reactivity Index (IRI; Davis, 1980)
2. IRI Perspective-Taking Subscale                         --
3. IRI Empathic Concern Subscale

Multicultural Case Conceptualization Ability
4. Etiology
5. Treatment

Variables                                          3       4

1. Previous Multicultural Courses Taken            .14     .30 ***

Interpersonal Reactivity Index (IRI; Davis, 1980)
2. IRI Perspective-Taking Subscale                 .25 **  .27 **
3. IRI Empathic Concern Subscale                   --      .47 ***

Multicultural Case Conceptualization Ability
4. Etiology                                                --
5. Treatment

Variables                                            5

1. Previous Multicultural Courses Taken              .18 *

Interpersonal Reactivity Index (IRI; Davis, 1980)
2. IRI Perspective-Taking Subscale                   .34 ***
3. IRI Empathic Concern Subscale                     .46 ***

Multicultural Case Conceptualization Ability
4. Etiology                                          .53 ***
5. Treatment                                         --

Note. Higher scores indicate a greater amount of the given variable.
* p < .05. ** p < .01. *** p < .001.
Table 2. Summary of the Hierarchical Multiple Regression Analyses
for Variables Predicting MCCA Etiology and Treatment Scores

Variables                                       Etiology

                                         B   SE B  [beta]     t

STEP 1
Previous Multicultural Courses Taken    .45  .12     .30    3.59 ***

STEP 2
Theoretical Orientation
  Humanistic                           -.03  .28    -.01    -.10
  Psychodynamic                       -1.27  .33    -.36   -3.79 ***
  Cognitive-Behavioral                -1.18  .36    -.31   -3.33 **

STEP 3
IRI-Perspective-Taking Subscale         .03  .03     .08    1.09
IRI-Empathic Concern Subscale           .14  .03     .33    4.35 ***

Variables                                      Treatment

                                         B   SE B  [beta]    t

STEP 1
Previous Multicultural Courses Taken    .25  .12     .18    2.06 *

STEP 2
Theoretical Orientation
  Humanistic                            .17  .30     .06     .56
  Psychodynamic                        -.78  .35    -.24    2.25 *
  Cognitive-Behavioral                 -.41  .37    -.11   -1.10

STEP 3
IRI-Perspective-Taking Subscale         .08  .03     .21    2.56 *
IRI-Empathic Concern Subscale           .15  .03     .36    4.46 ***

Note. MCCA = Multicultural Case Conceptualization Ability; IRI =
Interpersonal Reactivity Index (Davis, 1980). * p < .05. ** p < .01.
*** p < .001.

REFERENCES

Bernstein, W.M., & Davis, M.H. (1982). Perspective-taking, self-consciousness, and accuracy in person perception. Basic and Applied Social Psychology, 3, 1-19.

Carey, J.C., Fox, E.A., & Spraggins, E.F. (1988). Replication of structure findings regarding the Interpersonal Reactivity Index. Measurement and Evaluation in Counseling and Development, 21, 102-105.

Constantine, M.G. (2000). Social desirability attitudes, sex, and affective and cognitive empathy as predictors of self-reported multicultural counseling competence. The Counseling Psychologist, 28, 857-872.

Constantine, M.G. (2001). Theoretical orientation, empathy, and multicultural counseling competence in school counselor trainees. Professional School Counseling, 4, 342-348.

Constantine, M.G., Juby, H.L., & Liang, J.J-C. (2001). Examining multicultural counseling competence and race-related attitudes among White marital and family therapists. Journal of Marital and Family Therapy, 27, 253-362.

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

D'Andrea, M., Daniels, J., & Heck, R. (1991). Evaluating the impact of multicultural counseling training. Journal of Counseling and Development, 70, 143-150.

Davis, M.H. (1980). A multidimensional approach to individual differences in empathy. JSAS Catalog of Selected Documents in Psychology, 10, 85.

Davis, M.H. (1983). Measuring individual differences in empathy: Evidence for a multidimensional approach. Journal of Personality and Social Psychology, 44, 113-126.

Davis, M.H., Luce, C., & Kraus, S.J. (1994). The heritability of characteristics associated with dispositional empathy. Journal of Personality, 62, 369-391.

Day, H.I., & Chambers, J. (1991). Empathy and burnout in rehabilitation counsellors. Canadian Journal of Rehabilitation, 5, 33-44.

Egan, G. (1994). The skilled helper: A model for systematic helping and interpersonal relating (5th ed.). Monterey, CA: Brooks/Cole.

Fischer, A.R., Jome, L.M., & Atkinson, D.R. (1998). Reconceptualizing multicultural counseling: Universal healing conditions in a culturally specific context. The Counseling Psychologist, 26, 525-588.

Ladany, N., Inman, A.G., Constantine, M.G., & Hofheinz, E.W. (1997). Supervisee multicultural case conceptualization ability and self-reported multicultural competence as functions of supervisee racial identity and supervisor focus. Journal of Counseling Psychology, 44, 284-293.

Lazarus, A.A., & Beutler, L.E. (1993). On technical eclecticism. Journal of Counseling and Development, 71, 381-385.

Neville, H.A., Heppner, M.J., Louie, C.E., Thompson, C.E., Brooks, L., & Baker, C.E. (1996). The impact of multicultural training on White racial identity attitudes and therapy competencies. Professional Psychology: Research and Practice, 27, 83-89.

Norcross, J.C., & Newman, C.F. (1992). Psychotherapy integration: Setting the context. In J.C. Norcross & M.R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 3-45). New York: Basic Books.

Nystul, M.S. (1999). Introduction to counseling: An art and science perspective. Needham Heights, MA: Allyn & Bacon.

Ottavi, T.M., Pope-Davis, D.B., & Dings, J.G. (1994). Relationship between White racial identity attitudes and self-reported multicultural counseling competencies. Journal of Counseling Psychology, 41, 149-154.

Parker, W.M., Moore, M.A., & Neimeyer, G.J. (1998). Altering White racial identity and interracial comfort through multicultural training. Journal of Counseling and Development, 76, 302-310.

Pedersen, P.B. (Ed.). (1991). Multiculturalism as a fourth force in counseling [Special issue]. Journal of Counseling and Development, 70, 4-250.

Ponterotto, J.G. (1998). Charting a course for research in multicultural counseling training. The Counseling Psychologist, 26, 43-68.

Pope-Davis, D.B., Reynolds, A.L., Dings, J.G., & Nielson, D. (1995). Examining multicultural competencies of graduate students in psychology. Professional Psychology: Research and Practice, 26, 322-329.

Pope-Davis, D.B., Reynolds, A.L., Dings, J.G., & Ottavi, T.M. (1994). Multicultural competencies of doctoral interns at university counseling centers: An exploratory investigation. Professional Psychology: Research and Practice, 25, 466-470.

Ridley, C.R., & Lingle, D.W. (1996). Cultural empathy in multicultural counseling: A multidimensional process model. In P.B. Pedersen, J.G. Draguns, W.J. Lonner, & J.E. Trimble (Eds.), Counseling across cultures (4th ed., pp. 21-46). Thousand Oaks, CA: Sage.

Ridley, C.R., Mendoza, D.W., & Kanitz, B.E. (1994). Multicultural training: Reexamination, operationalization, and integration. The Counseling Psychologist, 22, 76-102.

Sodowsky, G.R., Kuo-Jackson, P.Y., Richardson, M.F., & Corey, A.T (1998). Correlates of self-reported multicultural competencies: Counselor multicultural social desirability, race, social inadequacy, locus of control racial ideology, and multicultural training. Journal of Counseling Psychology, 45, 256-264.

Sodowsky, G.R., Taffe, R.C., Gutkin, T.B., & Wise, S.L. (1994). Development of the Multicultural Counseling Inventory: A self-report measure of multicultural competencies. Journal of Counseling Psychology, 41, 137-148.

Steward, R.J., Morales, P.C., Bartell, P.A., Miller, M., & Weeks, D. (1998). The multiculturally responsive versus the multiculturally reactive: A study of perceptions of counselor trainees. Journal of Multicultural Counseling and Development, 26, 13-27.

Streufert, S., & Streufert, S. (1978). Behavior in the complex environment. Washington, DC: Winston.

Strupp, H.H., & Hadley, S.W. (1979). Specific vs. nonspecific factors in psychotherapy. Archives of General Psychiatry, 36, 1125-1136.

Sue, D.W., Arredondo, P., & McDavis, R.J. (1992). Multicultural counseling competencies and standards: A call to the profession. Journal of Multicultural Counseling and Development, 20, 64-68.

Sue, D.W., Carter, R.T., Casas, J.M., Fouad, N.A., Ivey, A.E., Jensen, M., LaFromboise, T, Manese, J.E., Ponterotto, J.G., & Vasquez-Nuttall, E. (1998). Multicultural counseling competencies: Individual and organizational development. Thousand Oaks, CA: Sage.

Sue, D.W., Ivey, A.E., & Pedersen, P.B. (Eds.). (1996). A theory of multicultural counseling and therapy. Pacific Grove, CA: Brooks/Cole.

Tetlock, P.E. (1986). A value pluralism model of ideological reasoning. Journal of Personality and Social Psychology, 50, 819-827.

Tetlock, P.E., Hannum, K., & Micheletti, P. (1984). Stability and change in senatorial debate: Testing the cognitive versus rhetorical style hypotheses. Journal of Personality and Social Psychology, 46, 979-990.

Tetlock, P.E., & Kim, J.I. (1987). Accountability and judgment processes in a personality prediction task. Journal of Personality and Social Psychology, 52, 700-709.

Tetlock, P.E., & Suedfeld, P. (1988). Integrative complexity coding of verbal behavior. In C. Antaki (Ed.), Analysing everyday explanation (pp. 43-59). London: Sage

Madonna G. Constantine is an associate professor in the Department of Counseling and Clinical Psychology at Teachers College, Columbia University, NY. Email [e-mail]. The author thanks Tina Arorash and Khym Isaac for their assistance with this project.