Extending the context-responsive psychotherapy integration framework to cultural processes in psychotherapy

Abstract

Psychotherapist competence in attending to cultural processes has long been considered an ingredient of successful treatment. Although some research findings support a positive association between clinician multicultural competence (MCC) and client improvement, others suggest that MCC may not be a skill that therapists uniformly acquire and then stably maintain. Rather, MCC is likely more fluid and contextualized, potentially rendering within-therapist variability across their patients and within-dyad variability across different moments in a given case. With such variability in perceptions and actual behavioral manifestations of therapist MCC, it may be important for clinicians to heed contextual markers that call for flexibility and evidence-informed responsivity. To this end, we extend Constantino, Boswell, Bernecker, and Castonguay's (2013) context-responsive psychotherapy integration framework, a pantheoretical, if-then approach to responding to common clinical process markers with modular, evidence-based therapeutic strategies. Specifically, we present a therapy case supporting that clients' social and cultural identities can serve as both specific-client contexts in themselves and unique factors that may influence other important therapeutic contexts (e.g., lowered client outcome expectation and alliance ruptures, client change ambivalence/resistance to treatment) that require context-relevant therapist responsivity. With this case, we provide examples both of successful responsivity and missed opportunities. (PsycINFO Database Record