Abstract
This paper provides a response to Ridley et al.’s Major Contribution on the state of multicultural counseling competence (MCC) and their proposed refinement and extension of this construct. They pose the following multiprong question: “Is multicultural counseling competence becoming outdated and supplanted, or is it underdeveloped and in need of refinement?” We use this question to examine the MCC model that Ridley et al. have proposed in this Major Contribution. We summarize and critique each paper, and close with our own conclusions about the above question. We are concerned that the characteristics of the clinicians seem to be secondary to MCC. We also question the lack of focus on the sociopolitical context and the limited inclusion of diverse scholarship in creating a universal MCC model.
Keywords
Significance of the Scholarship to the Public
In response to Ridley and colleagues’ Major Contribution on multicultural counseling competence, we raise key issues that are critical in strengthening the profession’s understanding and use of multicultural counseling competence.
Charles Ridley, Debra Mollen, and their coauthors in the Major Contribution have a long history of examining and questioning the meaning of cultural competence (Mollen et al., 2003; Ridley, Baker, & Hill, 2001). In particular, Ridley has spent his career clarifying and examining the meaning of key constructs in psychology. For example, in his examination of ethics (Ridley, Liddle, et al., 2001) and racism (Ridley, 1995, 2005), Ridley focused on how language shapes thought and therefore action. Particularly notable was his observation that the term unethical was problematic because no situation lacked ethical implications and his suggestion that the term ethically inappropriate should be used instead, as a more accurate and descriptive term (Ridley, Liddle, et al., 2001). In challenging vague language and thinking, Ridley has helped to elucidate concepts central to psychological practice and research for decades. Likewise, Ridley and Mollen have critically questioned the concept of cultural competence since 2003 (Mollen et al., 2003; Ridley & Kleiner, 2003). They have consistently called counseling psychologists to carefully define (and limit) their conceptual thinking so that both clinical and research progress could be made with regards to multicultural competence (Mollen et al., 2003; Ridley, Baker, & Hill, 2001). These authors have been active participants in the multicultural revolution, at the same time, they respectfully question its proceedings.
We are honored to engage in this important conversation and process with them. Thus, the purpose of this paper is to provide a response to the Major Contribution on the current state of multicultural counseling competence (MCC) and the proposal for the refinement and extension of this construct. In their Major Contribution Ridley and coauthors (Mollen & Ridley, 2021 [this issue]; Ridley, Mollen, et al., 2021 [this issue]; Ridley, Sahu, et al., 2021 [this issue]; Sahu et al., 2021 [this issue]) are to be commended for raising issues surrounding the state of MCC in the 21st century. Based on their review of the scholarly literature on MCC, they pose a multiprong question that we have unpacked into separate questions: (a) Is this construct outdated? (b) Is MCC underdeveloped? (c) Has it just been repackaged? or (d) Is it in need of refinement? Our goal is to use these questions to examine the MCC model proposed in this Major Contribution. Because MCC is a complex construct, our answers to these questions may not be as straightforward as we would like. There will be gaps or holes that we may overlook or be unable to address. However, our ultimate goal is to stimulate counseling psychologists, in collaboration with Ridley and his coauthors, to discuss and answer the questions on how the profession conceives of MCC and its use in education, training, and practice. To that end, we first provide a brief summary and critique of each article. We close this paper with our own conclusions about the proposed questions to support the profession in moving forward with MCC.
Rethinking Multicultural Competence
In the introductory article of this special issue, Mollen and Ridley (2021) ask the counseling psychology profession about MCC and then proceed to rethink or reevaluate all aspects of this construct. Their rationale for doing so being that the construct, “has stalled at a conceptual and operational impasse” (Mollen & Ridley, 2021, p. 491). Despite the proliferation of research on MCC, substantial issues still have not been addressed. They raise critical issues about MCC, such as the difficulty of translating MCC into practice, the gap between theory and research, the lack of a coherent definition of MCC, and the inconsistency in MCC training. In essence, these issues and various gaps in the MCC literature and their implications for practice motivated them to address the major impasses up to this point: What is yet to be known about MCC and how did the profession get to this point? To start the conversation, Mollen and Ridley (2021) focused on three areas: the historical context of the emergence of MCC, the status of MCC in professional psychology, and the organization of the Major Contribution, including the call to the profession to join in advancing the conversation on MCC. We primarily focus on the critical elements of the first two areas and then respond to the call for a conversation on MCC.
Historical Context of MCC Birth
Mollen and Ridley (2021) recognize how far the profession has come in meeting Sue et al.’s (1982) call to action on MCC. Now almost 40 years later, Mollen and Ridley (2021) issue a new call to the profession: “Is multicultural counseling competence becoming outdated and supplanted? Or is it underdeveloped and in need of refinement?” (p. 498). These questions are important in that scholars in the 21st century have continued to struggle with MCC and its use since it was first raised in 1982 (Sue et al.). We agree with Mollen and Ridley (2021) that the development and implementation of MCC occurred and has existed in a sociopolitical context. Over the 40-year span of MCC’s existence, that sociopolitical context has been continually changing. Across the centuries of human existence in the United States and possibly across the world, the quest for civil rights has been the same for marginalized groups, that is, women, racial/ethnic minorities, the poor, LGBTQ. However, each generation and corresponding decade have faced unique challenges in addressing these civil rights. The 21st century has not been any different. Entering the third decade of the 21st century, the women’s movement has been vocal about how women should be treated (e.g., the #MeToo Movement) as well as the younger generation of African Americans have become engaged in civil rights through #BlackLivesMatter. The LGBTQ movement also has made progress with the right to marry, and just like other cultural groups, has experienced the ebb and flow of progress toward and regression of their rights (Miller, 2020). Starting in 2020, the world has been living through the coronavirus disease 2019 (COVID-19) pandemic and it has laid bare the disparities of the have and have-nots, especially across race (Ogedegbe et al., 2020). Although the disparities are not new, the increased awareness is. For example, in 2021 Kamala Harris became the first woman and first Person of Color elected as vice-president of the United States. Will this new sociopolitical context make a difference in its expression and impact on the psychological professions? Is the profession reliving the past in new situations (from the Ku Klux Klan to Proud Boys, from lynchings to police shootings, from no voting rights to voter suppression)? Or is the past prologue? In essence, has all that has passed led to this moment of the reconceptualization of MCC? Is the profession still slow to react or because of technology, is the response both quicker and more progressive; and if the acceleration has occurred, to what end?
Mollen and Ridley (2021) stimulated the authors’ thinking and response about the importance of understanding MCC in context of the past, present, and future, as well as the need to be more critical in evaluating the infusion of MCC into the profession across all aspects of education, training, and practice. Have professional psychologists been responsive to the sociopolitical contexts of the decades or been standing still since the 1990s? What happens when a movement becomes stagnant or is at an impasse? Nowhere is the impasse more clearly evidenced than in the definition of MCC.
Status of MCC Construct
Mollen and Ridley (2021) rightly highlight the importance of MCC to the psychology profession, evidenced by the development of specific MCC professional guidelines as well as its incorporation into the field’s professional ethics and code of conduct. We agree with Mollen and Ridley (2021) that despite the prominence of the construct in the field, a lack of clarity continues to exist about the construct and its use. What would it mean to have a clearly defined construct? Is this quest even a realistic goal? Is it possible to get the profession to agree? Would a precise and consistent definition be considered too restrictive? For example, the initial focus of MCC was primarily on racial/ethnic minorities. Over the years, MCC has been defined to be inclusive of other underrepresented groups, such as gender, sexual orientation, disability, religion, and obesity. Some scholars (Vera & Speight, 2003; Worthington et al., 2007) have questioned whether this inclusive approach has led to a dilution of the meaning of culture as well as MCC. Do these opposing perspectives have an influence on the operationalization of MCC? The lack of definitional clarity has had an impact on operationalizing it in training and practice. We resonated with Mollen and Ridley’s (2021) comment about psychology graduate students reporting feeling stuck on how to translate the construct of MCC into practice. Is it that difficult or does it reflect the continued resistance of U.S. society, as well as the discipline, to embrace diversity?
For example, when professional psychology students start in the field, they are overwhelmed in developing the common skills in talking to a client. Guided by research, scholars have created best practices in establishing these helping skills through focused practice and repetition over time (Baker et al., 1990; Hill & Lent, 2006; Mayer, 2004). Expectations are clear as to what students must do to acquire these skills, including repeating this skills practicum until they can demonstrate a baseline knowledge. Only then are students permitted to engage in seeing clients. Usually, one practicum is not considered sufficient and there are required number of clinical hours that must be met. Setting up the development of clinical skills in this matter has resulted in most trainees becoming proficient or at least feeling efficacious in the basic therapeutic skills. The point is not about whether the trainees have become therapeutically effective, but whether they report feeling more confident in delivering counseling (Larson & Daniels, 1998; Mullen et al. 2015). Although counseling trainees are probably concerned about the training content and process of these skills, these concerns may not be equivalent to the continued discomfort instructors and students voice about developing MCC, from knowledge to skills (Milan & Bridges, 2019; Tomlinson-Clarke, 2000).
Call to the Profession
Mollen and Ridley (2021) made an excellent case for the renewed call for the profession to rethink MCC. They have been thoughtful in raising pertinent issues. However, we believe the profession needs to be pushed further in acknowledging and addressing whether their approach to MCC has been inconsistent in comparison to how other aspects of professional education and training have been codified through accreditation and licensure. We agree that there is an accountability issue, but we contend that the profession has not gone far enough to incorporate diversity in a lived way into the profession. Thus, we urge Mollen and Ridley (2021) to push the discourse further on the codification of MCC into the profession’s educational programs and training of MCC.
A Construct in Search of Operationalization
In the second article of the Major Contribution, Ridley, Mollen, et al. (2021) identify 10 definitional problems that act as barriers to the concept of MCC. Furthermore, they provide a brief review and critique of three major models of MCC. Their stated goal is for counseling psychologists to reconceptualize MCC into “a sound, applicable guide for practitioners’ work with diverse clients” (Ridley, Mollen, et al., 2021, p. 504).
Ridley, Mollen, et al. (2021) use the analogy of a GPS in taking a journey through MCC. Although we appreciate the effort of creating an analogy, we struggled with its usefulness. Faced with such uncertainty, the analogy of a GPS seems simplistic. A GPS relies on certainty, with discrete beginnings and endings; in finding a way from point A to B, one relies on geography and changing traffic conditions. Traffic applications, like Waze, use user reports to modify navigation in real time according to traffic conditions. Counseling theory and practice rarely have predefined destinations that are so clearly reached, much less multicultural interactions that reflect a system of systemic advantages and disadvantages that psychologists are socialized into. Furthermore, the analogy complicates the understanding of MCC, as it is distal to the profession and not as readily accessible in application.
In general, we appreciate the effort that Ridley, Mollen, et al. (2021) made in distinguishing between the use of multicultural competence and MCC based on the outcome: therapeutic change. Such precision may assist in a clearer focus for research and clinical practice. We appreciate making distinctions in related terms (e.g., competence vs. competency) and their linguistic use; and agree with Ridley, Mollen, et al. (2021) that the profession needs to discourage the indiscriminate use of words. Agreeing on definitions and usage would go a long way in improving research, its implementations, and its outcomes. Given their thoroughness in highlighting the definitional problems related to MCC, we focus on three definitional issues: (a) culturally general or specific; (b) the relationship between awareness, skills, and knowledge (ASK); and (c) the focus of MCC in relation to ASK.
Culturally General or Specific
We agree with Ridley, Mollen, et al. (2021) that the general–specific divide about MCC is an artificial one. Yes, all humans are cultural beings and, yes, people are more alike than they are different. And yes, it is important not to homogenize a group of people based on broad strokes of cultural traits. We additionally contend that it is a false narrative to assume that any person can become “multiculturally competent,” general or specific, or that any psychologist trained from either perspective is multiculturally competent. Furthermore, we contend that whether clinicians are on the continuum from specific to general, being multiculturally competent in counseling is a lifelong endeavor. Each perspective contains elements of the other. To use a culturally general approach with a client requires that the clinician must continue to work to understand the specific cultural characteristics of that client. Being too general may result in the clinician not fully understanding the client. On the other hand, a generalist perspective is needed to balance a culturally specific focus. Clients from a specific cultural background will not necessarily fit all elements of that particular cultural group. MCC needs to be viewed like a lens on a camera, wherein MCC and training in culturally specific and general perspectives are the key for clinicians to zoom in and out in order to find the best vantage point to view and understand their clients. This issue strikes at the heart of MCC training and the belief in life-long learning. Although competence may lie in the intentional incorporation of culture, not the use of different interventions specific to each group, clinicians still need to learn how to balance general and specific views of culture. Intentionality does not necessarily equate with actual use.
What is also missing from this cultural divide is the need for specificity regarding the sociopolitical context in working with clients. Clinicians need to stay abreast of current events. For example, a culturally generalist approach would be insufficient and possibly inappropriate in addressing the needs of clients who have been affected by the COVID-19 pandemic. Race may matter, given the racial disparity in infection and death rates. Social class may matter, as well as geographical location. Although the exposure to the COVID-19 pandemic has been worldwide, the effect and its impact have not been general nor universal. Again, the heart of the matter is not about taking a culturally specific or general approach; the issue is that clinicians must be trained to take on both approaches, to be more transactional, and to be proactive in knowing the sociopolitical realities. Although it would be impossible to know everything, it is important to be as informed as possible. Given the various ways of staying informed, it is not acceptable to be unaware or to maintain a limited awareness and knowledge about the sociopolitical realities of clients.
Whole or the Sum? Character, Skill, or Process?
We appreciate the nuance of spelling out the relationship between ASK (awareness, skills, and knowledge) to MCC and the integration of these constructs (fourth definitional problem). In regard to the tenth definitional problem, we appreciate that Ridley, Mollen, et al. (2021) address the differing assumptions about the nature of MCC. Is it a characteristic of the clinician, is it an application of skills, or is it a process that unfolds in therapy? Using the same term to describe a different aspect of MCC is problematic. Thus, some nuance in writing about MCC is needed. We believe that all three aspects are integral to clinicians developing MCC and that theoretical conceptualization of MCC needs to include the intertwining of the three and their use in training clinicians.
Three Major Models
Ridley, Mollen, et al.’s (2021) brief summary and critique of the three major theoretical models of MCC are helpful and they make the case for a reconceptualization or integration of such models. We revisit these models in reviewing the process model that Ridley, Sahu, et al. (2021) present.
The Process Model of MCC
Ridley, Sahu, et al. (2021), in the third article of the Major Contribution, introduce the process model of multicultural counseling competence. Prior to presenting the model, the authors present a redefinition of MCC as opposed to multicultural counseling competencies and delineate the centrality of deep-structure incorporation of culture in the construct. We will first address these two areas and then address the process model.
Redefining MCC
Ridley, Sahu, et al. (2021) deconstruct the term MCC and situate multicultural counseling competencies as subordinate aspects of MCC. In general, the redefinition of both terms is acceptable when focused on one aspect of the clinical work. They define, “multicultural counseling competence as the facilitation of therapeutic change through the deep-structure incorporation of culture into counseling and psychotherapy” (Ridley, Sahu, et al., 2021, p. 536). In contrast, Ridley, Sahu, et al. define multicultural counseling competencies as “actionable and purposeful behaviors that clinicians employ to translate multicultural concepts and ideas into the facilitative activities of therapeutic change” (pp. 536–537). Although acceptable, we have concerns about these definitions. One, the definitions (competence vs. competencies) appear to be one-sided. For both, the focus is on the implementation of therapeutic change in the client. Although the change in the clinicians may be implied in how multicultural counseling competencies is defined (i.e., actionable and purposeful behaviors clinicians employ to translate multicultural concepts and ideas), the absence of explicitly defining competence and competencies to be about the clinicians themselves, instead of actions directed toward the clients, is troubling. This concern goes back to the assumption about the nature of MCC that Ridley, Mollen, et al. (2021) raise: characteristics of the clinicians, application of skills, or process of therapy. We thought that raising the divergence of these views of MCC laid the foundation to articulate how the three views could be reconciled and used in an integrated way. Maybe an integrated approach is intended; however, what is written does not live up to this expectation. As written, the approach to the process model comes across as primarily skills-based—the clinician’s focus on the client. If the focus is solely on the clients, is it possible for the clinicians to evade two of the key aspects of MCC and competencies (the effect of affect and attitudes of the clinician on the counseling process)? Again, these elements may be implied in the definitions, but it would be helpful to spell them out.
Furthermore, psychotherapy is not the only clinical space that professional psychologists demonstrate MCC and competencies. Narrowing the lens to focus solely on the counseling process limits the varied roles that psychologists have in the helping profession that require the use of clinical skills. Should “client” be broadly defined to reflect the various entities and roles that professional psychologists (consultants, instructors) have? This level of specificity is needed to convey the full range in which MCC and competencies may operate. The focus on the client in a clinical context gives precision to the definitions, but such focus also restricts the definitions, decreasing the likelihood of psychologists embracing and using these definitions over the long run. This restrictive and one-sided focus also allows psychologists to avoid some of the more difficult aspects of MCC and competencies: the affective and attitudinal aspects of awareness. These definitions seem to focus on the behavioral and skill-based aspects of training. On one level, the focus on skill development is important and integral to clinicians developing MCC and competencies. However, scholars have found that awareness (affective and attitudinal) aspects of MCC are the most challenging to change, as they are situated within a sociopolitical context (e.g., racial socialization of children; Loyd & Gaither, 2018), in which professional psychology is a microcosm. For example, Bezrukova et al. (2016) conducted a meta-analysis of 40 years of research on diversity training evaluation. They found that diversity training had the largest effect on general reactions (e.g., awareness), followed by cognitive learning (e.g., knowledge). Reactions to diversity training and attitudinal/affective learning were found to decay after training, whereas knowledge was maintained over time after training. There were similar challenges about skills-based training. In sum, all aspects of MCC need to be incorporated into the definitions of MCC and competencies. Otherwise, the model does not reflect an integrationist approach and may ignore the aspect that requires the most work—the characteristics of the clinician.
How Much Culture to Incorporate Into the Process?
We appreciate that Ridley, Sahu, et al. (2021) focused on delineating the meaning of culture and its juxtaposition to competence and competencies. We are in agreement with their definition of culture as well as the importance they place on culture in counseling transactions. However, their focus on culture falls short, just as their definitions of competence and competencies. The focus continues to be one-sided—the impact of culture on the client. As a result, little is stated about culture and clinicians other than they must be responsible for managing culture in the relationship. We agree. Yet, how they manage culture in the relationships requires a focus on the clinicians themselves—their awareness about their attitudes and feelings about their culture and the cultures of others. We do not believe that building skills on how to manage culture in counseling is sufficient to determine that clinicians have the necessary level of MCC and possess the necessary multicultural counseling competencies. This approach to focus primarily on skill-building is a missed opportunity to push the profession further in grappling with the most difficult part of MCC and competencies: awareness. Winston Churchill, in a 1948 speech, stated, “Those who cannot remember the past are condemned to repeat it” (Santayana, 1905/2017; p. 132). We believe cultural awareness is a core feature of MCC and competencies. Without addressing and facilitating its development in clinicians, we as a profession reinforce the process of repeating the same cultural mistakes made by past generations—the perpetuation of systemic and individual oppression.
Gone’s (2010) question, “How much ‘culture’ is required for the culturally competent practice of psychotherapy with the culturally different” (p. 169), is provocative and interesting. Should the question instead be, how can one tell that culture is being adequately addressed in the relationship to result in an effective outcome? Based on anecdotal evidence, we contend that there is a place for surface as well as deep-structure incorporation of culture. We have had clients who have inquired about our ethnicity. Knowing the ethnic status of the clinician seemed to serve as an initial maintenance tool of the client staying in counseling. There have been clients who did not want to talk about their sexual orientation or racial issues but still stay engaged in the therapeutic process to focus on other issues (e.g., academic performance, substance use) and to improve over the long-run, up to a year later posttherapy. Good intentions may not be sufficient, and this anecdotal evidence of the surface incorporation of culture may reflect some underlying deep-structure of incorporation of culture (comfort level of clinicians) that was not unpacked. Although we support the deep structure incorporation of culture, we question whether this delineation from surface structure is sufficient. For example, the elaboration likelihood model (Petty & Cacioppo, 1986) is used to describe how attitude formation and change may occur through a peripheral (surface) or elaborate (deep structure) process. No evaluation needs to be made about which is better, but that both exist in forming and changing attitudes. The same may be the case for the status of surface versus deep structure incorporation of culture. Thus, more is needed to address how surface and deep structure work together to have an effective cultural outcome. To date, we know of no studies that have examined the parallel views of clinicians and clients about these matters. Pope-Davis et al. (2002) examined multicultural competence in the context of psychotherapy from the perspective of clients, resulting in a model to depict the client’s needs. To attempt to answer this complex issue is to initiate a long-term inquiry about what clinicians thought they had employed as (a) a cultural intervention, (b) the type of cultural intervention (deep vs. surface; general vs. specific), and (c) the “amount” of culture, all in relation to the clients’ perspectives.
Presentation of the Process Model of MCC
We agree that MCC is complex and involves dynamic interactions among various elements. As a result, we applaud Ridley, Sahu, et al. (2021) in presenting a reconceptualized model of MCC. Their willingness to offer such a model and be open to criticism will only move the field forward in better understanding MCC.
Foundational Principles
Most of the foundational principles are understandable and are helpful in setting up the process model. However, we are concerned about Principles 2 and 3. We have already noted above and agreed with Ridley, Mollen, et al. (2021) about the artificial divide between a culturally general or specific approach to MCC. As a result, we are concerned that the model falls on the culturally general side. If this model is to reflect an integrationist approach, then such an approach should be the foundational principle of the model. Whether implicit or explicit, all forms of helping are culturally laden and therefore, more culturally specific than is known or ever acknowledged. Although not intentional, taking a generalist approach invites educators, supervisors, and trainees to take a universal approach to counseling, which is already the status quo. This aspect of the model is neither new nor a refinement.
We are equally concerned about the preference for a process-oriented over a content-oriented model, as again, we had expected an integrationist approach. The process of psychotherapy is necessary but is not sufficient in terms of MCC. Content at the surface-level, deep-structure, and group specific interventions, is just as necessary. To focus on process over content again reflects the status quo. This aspect of the model is also neither new nor a refinement.
As we have indicated above and reassert here again, sociopolitical context is important. In several instances, there were references to “all counselors” (see Ridley, Sahu, et al., 2021), in this case, “all counselors, not just those who are ethnically or culturally similar to their clients, should develop deep-structure incorporation of culture” (Ridley, Sahu, et al., 2021, p. 540). Given the current demographics of psychology as a predominantly White profession, we are curious as to why, although Whites are acknowledged to have a race and culture, there is no context to acknowledge that Whites must identify and root out White supremacist thinking? All counselors are not created equal, not trained equally, nor valued equally. By insisting that the model fit “all counselors,” are we losing the majority of White, female counselors who make up most of the profession in the modern era? Are we ignoring a relevant contextual factor in the multicultural context of White, female trainees? It should not be assumed that counselors of color are culturally competent, especially as the majority of counseling psychology students are trained in programs at predominantly White institutions. Ridley, Sahu, et al. (2021) seem to contribute to this diffuse purpose by stating, “Consequently, the model does not exclude counseling relationships in which counselors and clients fit into predetermined racial, cultural, ethnic, religious, and lifestyle groups” (Ridley, Sahu, et al., 2021, p. 542). We are not sure what this statement means, given the reality that the majority of counselors are White. Given the precision of the language employed throughout the MCC, we find ourselves wondering what the point of this disclaimer is and furthermore, what is a “lifestyle group”? Is this meant to refer to LGBTQ people?
A further example of missing context is that, in the present day, we as a country are collectively undergoing a period of unprecedented social upheaval with the triple threat of (a) the COVID-19 pandemic that has disproportionately impacted People of Color; (b) social unrest, demonstrations, and continued police brutality in the aftermath of the murder of George Floyd; and (c) the aftermath of the 2020 presidential election. During this time, the awareness of White supremacy, health disparities, activism, social injustice, and systemic racism have become common parlance in political debates and in other areas of public discourse. The individualistic focus inherent in the process model contrasts with the need for systemic change and understanding of the ways that historical and contemporary oppression has shaped the experiences of People of Color in the United States. Reading their work in today’s context, it seems that Ridley, Sahu, et al.’s (2021) view of multiculturalism seems defined, and therefore limited, by their roles as members of The Society of Counseling Psychology and the American Psychological Association (APA). This model seems grounded (and limited by) the APA “bubble.” There is scant attention in this model to clinical wisdom, guidelines, and research generated by Psychologists of Color outside of mainstream professional psychology (e.g., Asian American Psychological Association, the Association of Black Psychologists, National Latinx Psychological Association, the Society of Indian Psychologists) who are not formally part of APA, or by critical scholars who have questioned and pushed back on systemic racism through the use of critical race theory (Bell, 1995; Crenshaw et al., 1995; Delgado & Stefancic, 2001). Ethical mandates are referenced as coming from APA, but none of the ethical, research, or practice guidance offered by the ethnic minority psychological associations, either as individual associations or collectively, are mentioned.
In addition to not focusing on the contributions of Psychologists of Color, Ridley, Mollen, et al. (2021) point out that the “exclusion” of White clients from multiculturalism “muddies the definition” (p. 508). Given that the majority of psychological theory is based on exclusively White middle-class samples, is there really a need to specify that Whites have a racial–ethnic identity and cultural context? This point is reminiscent of the slogan “all lives matter” in response to the Black Lives Matter movement. Care must be taken in appealing to a universalist approach. Given the historical and contemporary context, such an approach can be used to support White supremacy. For example, the authors (Ridley, Mollen, et al., 2021) point out, “everyone shares 99% of the underlying gene sequence” (p. 509), and that “we incorporate culture in counseling to facilitate the common internal process of therapeutic change applicable to all people” (pp. 509–510). These statements have the potential to be used to ignore the underlying power dynamics that perpetuate structural inequality. In addition to an individualistic approach, we note that in Ridley, Sahu, et al. (2021) when intersectionality is referenced, the citation given is from a White professor from the United Kingdom. In his article, Hopkins (2019) acknowledges that intersectionality is a result of Black feminist thinking, yet his work is the one being cited. Therefore, a White male is the one referenced for a contemporary Black feminist theory. This process of commodification is part of systemic racism (and in this case, also, sexism) and has been pointed out recently by Black academics (e.g., Leong, 2013). Without the critical questioning of the structures that perpetuate White supremacy and render Black, Latinx, Asian American and Native clients, psychologists, and researchers invisible, how are students and professionals to achieve MCC? In essence, the danger is that the process model of multicultural counseling competence may ignore the context that counseling psychologists and trainees are socialized in a system of European hegemony, that as Ridley, Mollen, et al. (2021) point out, has also maintained the often unintentional and unseen influence of White supremacy. By relying primarily on APA’s standards for the definition of psychology, much is lost in the potential of the model. Nothing in the model precludes information from nontraditional sources, yet we wish that the model would actively incorporate theory, practice, and research from outside mainstream psychology and across disciplines. To develop a universal model of MCC requires the inclusion of the scholarship and practice of all cultural groups. Otherwise, this model is not a refinement, but, inadvertently, a repackaging to maintain the status quo.
Design of the Process Model of MCC
Ridley, Sahu, et al. (2021) lay out the design of the model. It is ambitious and complex. However, we are puzzled by the following statement: “To use the process model, clinicians understand that it does not replace but complements counseling and psychotherapy” (Ridley, Sahu, et al., 2021, p. 544). Our question is, why not? If all counseling is cultural, should not a meta-MCC model become the standard for the profession in which all interventions and theories need to reside (see Sue et al., 1996)? Is not one of the primary problems of the field of counseling psychology and its training the lack of fully incorporating culture as foundational to all aspects of psychology instead of treating it as a side note? However, culture is not treated as a side note with the following statement by Ridley, Sahu, et al. (2021): “From the outset of counseling, clinicians should keep in the forefront of their thinking the superordinate function of the deep-structure incorporation of culture” (p. 544). Such a statement pushes the field forward in making MCC a foundation of all counseling.
We were glad to see the incorporation of ASK in the preparation phase of the clinicians. More space needs to be devoted to their relationship, as Ridley, Mollen, et al. (2021) called for earlier. These components need to be unpacked as well as their relationship in facilitating MCC in the clinician, in the process, and the outcome. This elaboration requires tenets that could be testable.
The focus on multilevel dynamic interactions highlights the potential comprehensiveness of the model to be useful for all counseling and could serve as a replacement for existing models. We like the clinical operations of adapting interventions, infusing preparation, and developing a therapeutic alliance (Cultural AID). More elaboration of this set of operations would be invaluable and could give more guidance to implementing all interventions in a culturally sound manner. We also appreciate the delineation of the three subordinate multicultural competencies: gathering, interpreting, and integrating cultural data. Furthermore, Ridley, Sahu, et al. (2021) revisit and suggest for clinicians to familiarize themselves with the general characteristics of the population. This suggestion seems contradictory in light of how counselors are encouraged to address being culturally general or specific as well as how they need to focus on being process- versus content-oriented. This same confusion exists in highlighting the use of the ADDRESSING framework (Hays, 2016) or the RESPECTFUL model (D’Andrea & Daniels, 2001).
We appreciate Ridley, Sahu, et al.’s (2021) inclusion of transtheoretical, transdiagnostic criteria for assessing and interpreting the cultural influence on the client’s functioning (see p. 552). However, it was unclear where these criteria were culled. Although the five criteria are general in nature, to truly use them would require specific details and an understanding of the client’s culture. The same critique applies to the use of the five decisional tasks; their use requires cultural specificity.
Ridley, Sahu, et al. (2021) are to be commended for creating and proposing a highly sophisticated MCC model. We are in agreement with most of the components in the process model, and appreciate the central role of culture in the process. However, more of the process model needs to address the role of culture in the clinicians’ life and in the context of sociopolitical aspects of society. Because the client–clinician process occurs in the context of society, we do not believe that culture can safely and cleanly be “managed in a clinical setting.” Embedded in the clinical setting are the cultural characteristics of society, such as White supremacy, the perceptions of various ethnic groups, views about religion and LGBTQ, and disparities such as those based on race, gender, and social class. It is important to take into consideration who the counselors primarily are, White females, as informative information about the potential challenges to emerge in the client–clinician relationship, process, and outcome.
Although we appreciate and value such an insular and focused approach on the clinical aspect of counseling, MCC is more than a clinical process. It lives in every aspect of people’s lives, including the structure of professional graduate programs. From the time students enter into their program to the moment they no longer practice, a systematic approach must be established and used across programs to embed MCC as the core of the profession. Such an approach allows clinicians to identify and address oppression, while dismantling White supremacy. Otherwise, how can MCC thrive?
Application of the Process Model of MCC
Multicultural counseling competency scholarship has clearly established the importance and critical role of culture in working with clients. In developing the process model, Ridley, Sahu, et al. (2021) provide a recursive framework for psychologists to better assess and integrate culture into psychotherapeutic work. In the last article of the Major Contribution, Sahu et al. (2021) provide an illustration of the process model by using a client-case generated by the authors. In the case, the counseling psychologist is Dr. Morgan, an African American woman, who is helping to identify and treat the presenting problems of academic performance and anxiety presented by Celeste Liu, a Chinese American 19-year-old cis-gendered and heterosexual woman. The process model is used to demonstrate how the psychologist is able to take a deep structural approach to incorporating the client’s culture by continually processing cultural and individual data from the client to help Dr. Morgan create a trusting and therapeutic alliance and to inform her interventions. Sahu et al. (2021) demonstrated how the strength of the alliance helps to bridge and resolve a therapeutic misunderstanding, and how the client eventually is able to internalize the need for change.
Context of Culture or the Cultural Context
Within the process model framework, the deep-structural incorporation of culture is the core aspect to the counselor’s approach and work with clients. In contrast to a shallow-incorporation of culture such as focusing on demographic aspects of a client, the deep-structural approach examines the meaningfulness of culture and identity, and its impact on the client’s wellbeing. In the case of Celeste, her cultural background is the main influence of her behaviors and attitudes and a primary source of her anxiety and her initial misunderstanding of how counseling would work. Dr. Morgan’s role is to gather cultural data and incorporate it into her knowledge, awareness, and skills, as well as into her intervention and termination processes. In using the process model, Dr. Morgan is conceptualizing Celeste’s Asian culture as the context of her behaviors. Celeste’s Asian culture, like Dr. Morgan’s cultural heritage, is the context of her culturally-based and driven behaviors, worldviews, and values. Because the client’s culture serves as the primary context for her presenting issues and the source of her cultural data, the client’s culture becomes the gateway to a multiculturally competent therapy process. This process model, as proffered by Ridley, Sahu, et al. (2021), is what we refer to as a culture-as-context therapy process, and it is, in many ways, undifferentiated from previous MCC models and frameworks where the culture of the client (who is often the Person of Color), is the main focus of attention and the critical feature in forging the therapy relationship and interventions.
The clinical perspective we have about Celeste is that her subscription to her cultural values and expectations (e.g., extremism, self-defeat, resistance) is the cause of her psychological distress (Ridley, Sahu, et al., 2021). In their description of Dr. Morgan’s work, she is trying to determine if the psychological distress is “culturally driven or unique to Celeste.” It is this perspective about culture and the person that is fairly specific to the operation of the process model. This basic assumption about how culture can be discrete and differentiated from the individual (client and counselor) runs counter to current perspectives on clients in which cultures, worldviews, beliefs, and values are inseparable from who clients are as individuals (Settles et al., 2020). More specifically, for many psychologists who regard themselves as culturally competent, Celeste’s Asian cultural heritage is also who Celeste is as an individual and therefore there is no distinction between culture and the individual. Certainly, there may be struggles between one’s adherence to one’s cultural heritage and its practice in a White dominant ecology, but that cultural tension represents the whole self, not just a cultural self. Similarly, in describing Dr. Morgan, Sahu et al. chose to describe her as informed by her Baptist upbringing, but that she holds herself to high standards such that “she avoids imposing her values onto clients and realizes that her awareness cannot be a static process” (Sahu et al., 2021, p. 571). The authors go further to describe the therapist’s theoretical orientation as integrative and person-centered. But even for Dr. Morgan, her cultural upbringing and worldviews are not separable from her practice; her choice of theoretical orientations, like many practicing psychologists, are a means by which she expresses her values and cultural worldview with the least amount of intrapsychic conflict or tension. In other words, psychotherapy theoretical orientations are not randomly selected but cohere around how psychologists see themselves, their relationships, and their understanding of illness and healing.
In presenting the case illustration, it is clear that the operationalization of culture and its privileged role in the process model also creates conceptual confusion with other constructs like racial identity, intersectionality, and experiences with racism. In Sahu et al.’s (2021) description, Celeste’s intersectional identities are juxtaposed against her racial identities, which the authors describe as Chinese American (an ethnic identification). The authors then go on to describe how some of Celeste’s identities may be “prone to discrimination, prejudice, or stereotypes” (Sahu et al. 2021, p. 577), rather than saying that Celeste may experience racism as a racialized Woman of Color (Wong-Padoongpatt et al., 2020). Here identities, even intersectional identities, are described as separate identity aspects of Celeste rather than inseparable aspects of who Celeste is as an Asian American Woman of Color within a White dominant cultural context.
The therapy illustration expertly describes how the process model effectively operates if the therapeutic eyes are turned toward the client’s culture and identities. Yet, what is missing from the process model is a description of how the client’s culture is also embedded within the larger White racialized cultural context and what effective therapy looks like when psychological distress is caused by a Woman of Color trying to thrive in a racist environment. Rather than conceptualizing clients’ subscription to their own culture as a source of psychological distress, a deep-structural incorporation of culture could explore the ways in which clients make sense of themselves through their experiences of gendered racism (Lewis et al., 2017). Thus, one of the limitations with the process model is that while the definition of culture is specific, the clinical activity example by Dr. Morgan uses culture as a catch-all construct, seemingly a surface incorporation of culture, to represent identities, ethnicity, race, gender, and social class, instead of a deep-structure approach. In this conflation of these multiple constructs, Dr. Morgan’s therapeutic approach avoids discussions of color or power. In other words, an understanding of intersectionality means race is always implicated in the experience of a Woman of Color, and even though they may initially disregard its importance, a multiculturally competent psychologists would know that Celeste’s minimizing of its significance is deeply and culturally rooted and needs further exploration. Otherwise, the approach does not reflect a deep-structure approach but a surface approach that Ridley, Sahu, et al. (2021) have indicated as not integral to the process model.
A final limitation of the process model, evident throughout the case illustration, is that traditional psychotherapy approaches are left intact and used without much regard for the cultural encapsulation of these therapy approaches (Benish et al., 2011). Sahu et al. (2021) described various therapeutic approaches, like dialectical behavior therapy (Linehan, 1993), but did not offer much advice for clinicians on how to use cultural frameworks to determine whether a particular theoretical orientation is appropriate. Ridley, Sahu, et al. (2021) described the process model as a complimentary framework to traditional theories—an adjunct to traditional counseling work. Thus, within the process model, theoretical orientations like dialectical behavior therapy are used, and simply adapted to make it more effective for the client.
Conclusion and Final Thoughts
Ridley and the coauthors of the Major Contribution are to be applauded for taking on such an ambitious project—re-examining and reproposing a model of MCC. Almost 40 years have elapsed since Sue et al. (1982) made that first call to the profession. The call and counseling psychologists’ response to it has resulted in a voluminous amount of literature on MCC. Taking on the ambitious project of wading through the literature of numerous definitions and linguistic ambiguity came with the knowledge that gaps would be missed, other areas of ambiguity would arise, and, of course, critiques would be made. Below, we briefly summarize our evaluation of this Major Contribution as well as provide answers to the initial questions posed by Mollen and Ridley (2021).
We agree with Ridley and the coauthors of the Major Contribution that MCC is outdated and underdeveloped, and in need of refinement. We appreciate that they have attempted to update MCC and to extend its development. They have refined the precision of the terminology and called to the profession to re-engage in setting guidelines toward that end. Precise terminology will strengthen scholars’ understanding of the research, as well as set guidelines for education and training. There will need to be room to update the terminology as well as incorporate new terms that will undoubtedly emerge.
The process model of MCC has potential. As an amalgamation of the three models reviewed, Ridley, Sahu, et al. (2021) attempted to create an integrationist model that reflects the best model possible. Striving to create a coherent and holistic model is applauded. However, there are several aspects of the process model that need to be revisited. One, false narratives continue to be perpetuated about certain concepts that are necessary for the process model. Taking a culturally general or specific approach should not fall under an “either, or” choice category. Both approaches have pros and cons, and both should be used in training and practice. The continuum of theories and worldviews need to be embraced by the profession, and to the extent possible, education and training should also incorporate both. Why should MCC be treated differently than theories that range from general to specific in the counseling field?
The same goes for the concept of deep-structure versus surface-structure. An integrative approach is needed in using these concepts in the service of MCC. Again, both aspects are necessary to move a client forward. Despite the concerns raised by Ridley, Sahu, et al. (2021) about the use of surface incorporation of culture, its application seems to be used quite freely in the examples used by Ridley, Sahu, et al. (2021), as well as in the case presented by Sahu et al. (2021). Their conceptualization and use of surface-deep structure incorporation of culture need to be revisited. As is, there appears to be a discrepancy between the conceptualization and the use of these concepts.
There are two other aspects that appear to be major shortcomings of the process model that need to be addressed. We appreciate that the focus of the process model is toward therapeutic change, resulting in greater focus on the client. However, this approach may give clinicians the impression that MCC is all about the client, not about them or the process. ASK is highlighted as an aspect of the process model, but it appears to be presented as a secondary aspect, rather than a primary one. Ridley and the coauthors of the Major Contribution may consider these elements in-service to therapeutic change. Although we believe they are, we additionally believe ASK is crucial to the therapeutic process and change. How skillful clinicians are is based on their level of awareness and insight about themselves, as well as their level of knowledge about the therapeutic process. Culture matters in all aspects of clinicians’ development, especially in terms of personal development and the work of becoming multiculturally competent.
Related to the focus of the model is the absence of context and the lack of cultural inclusion of scholarship outside of mainstream psychology. The sociopolitical context is not mentioned at all. This absence is magnified in the context of the Black Lives Matter movement and its pivotal role in responding to the death of George Floyd and Breonna Taylor, as well as the acknowledgement of racial disparities as a result of the COVID-19 pandemic. Such highly publicized events and the public’s response need to be taken into account in training clinicians and treating clients. Clinical skills are not sufficient if clinicians are not culturally aware or knowledgeable about what is going on around them. Without clinicians’ understanding the sociopolitical context of the client, we question how successful counseling/therapy will be. These current events have only re-emphasized the importance of context in the profession and in counseling models, such as the process model.
We also contend that it is no longer possible to create models, train clinicians, or practice in a universal vacuum. To take a universal approach to MCC and for it to become foundational to the profession requires the inclusion of all aspects of culture, to the extent that is possible. We have always lived in a cultural world, but for centuries the hegemony for psychology has been primarily based on a Western European framework (Guthrie, 2004; Katz, 1985; Naidoo, 1996), despite the contributions of other scholars from other cultural backgrounds. We are troubled that this model does not reflect this inclusion in theory and scholarship. To not be inclusive seemingly perpetuates the same hegemony, as well as the inadvertent maintenance of White supremacy. Such inclusion would make this model an exemplar of where the field needs to go in order to truly have a universal approach to not only MCC, but to counseling in general. In light of the Black Lives Matter movement, the public deaths of Black men, women, and children by police, and the COVID-19 pandemic, racial disparities have been laid bare. Can MCC truly be operationalized or theorized without addressing oppression, such as White supremacy?
In conclusion, Ridley and his coauthors are attempting to move the profession forward by making MCC an integral aspect of education, training, and practice. It should be the default of all counseling, not inserted on a periodic basis. To ensure its contribution to counseling psychology and MCC literature, it is important that scholars initiate a new dialogue on the fundamental role of MCC in the profession, starting with the process model. In the spirit of initiating such a process, we applaud them but demand more from Ridley and his coauthors, the process model, and the profession. The zeitgeist, i.e., the spirit of our times, provides the profession a path forward in order to be inclusive not only in spirit, but in practice.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
