Journal of Consulting and Clinical Psychology Copyright 2005 by the American Psychological Association

2005, Vol. 73, No. 5, 787789 0022-006X/05/$12.00 DOI: 10.1037/0022-006X.73.5.787

Introduction to the Special Section on Multicultural and Community

Psychology: Clinical Psychology in Context
Gordon C. Nagayama Hall
University of Oregon

Human behavior occurs in the contexts of culture and community. Yet, clinical psychology has
traditionally focused on the individual, neglecting the individuals context. The purpose of this Special
Section is to address the underlying conceptual issues in integrating multicultural and community
psychology within a common framework. The integration of etic and emic approaches distinguishes the
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

research programs in these articles from others that have solely focused on universal or culture-specific
This document is copyrighted by the American Psychological Association or one of its allied publishers.

approaches. Issues facing ethnic minority populations are addressed, including identification of risk and
protective factors, obstacles to mental health service use, and optimal treatment effectiveness. The
integration of culture and community contexts into clinical psychology is necessary for it to remain
relevant in an increasingly diverse 21st century.

Human behavior occurs in the contexts of culture and commu-
nity. Culture and community are so pervasive that they are often
invisible until we step outside our own context and realize that
there are cultural and community contexts other than our own.
Clinical psychology has traditionally focused on the individual.
However, to fully understand human behavior, individuals must be
studied in context. Moreover, effective mental health interventions
will need to address multicultural and community factors, both in
the manner in which mental health is conceptualized and in deliv-
ery of interventions that prevent or treat mental health problems.
The United States is ethnically diverse and is increasing in its
diversity. According to the 2000 U.S. Census, non-Hispanic Whites
were 69% of the population (http://www.census.gov/ipc/www/
usinterimproj/natprojtab01a.pdf). By the year 2050, non-Hispanic
Whites are projected to be 50% of the population. Although the
non-Hispanic White population is projected to grow only 7% over
the next 45 years, projected growth is 71% for African Americans,
213% for Asian Americans, and 188% for Hispanic Americans
(http://www.census.gov/ipc/www/usinterimproj/natprojtab01b.pdf).
Multicultural psychology is the study of the influences of mul-
tiple cultures in a single social context on human behavior (Hall &
Barongan, 2002). Cultural traditions and practices of particular
groups influence behavior, as do sociocultural influences that
result from the coexistence of multiple cultures, including accul-
turation and discrimination. Multicultural psychology is distinct
from cultural psychology or cross-cultural psychology because of
its consideration of the interaction of cultural and sociocultural
influences. Cultural psychology considers cultural influences on
behavior within single cultural contexts (Shweder, 2000), and
cross-cultural psychology considers cultural differences across dif-
ferent national contexts (Segall, Lonner, & Berry, 1998), but
Work on this article was supported by National Institute of Mental
Health Grants R01 MH58726 and R25 MH62575. I thank Mark Eddy for
his comments on a draft of this article.
Correspondence concerning this article should be addressed to Gordon
C. Nagayama Hall, Department of Psychology, 1227, University of Ore-
gon, Eugene, OR 97405. E-mail: gnhall@darkwing.uoregon.edu
neither primarily focuses on cultural and sociocultural influences
simultaneously.
Community psychology has studied the relationship of individ-
uals to the social environment (Seidman, 2003). Prevention of
psychopathology before it develops is a major goal of community
psychology (Tseng et al., 2002). An important component of
prevention is the identification of risk and protective factors asso-
ciated with psychopathology for the purpose of reducing risk and
enhancing protective factors (Coie et al., 1993; Tseng et al., 2002).
Another important component of community psychology is the
application of interventions in communities.
Although they both consider context, multicultural and commu-
nity psychology traditionally have been parallel fields. There is
little overlap between researchers in either field, and the two fields
have not cooperated to create an interdisciplinary scientific
agenda. Indeed, multicultural psychology has typically empha-
sized an emic approach that is generated within specific cultural
contexts. Such an approach in isolation may fail to be situated
within mainstream psychology and become marginalized. Con-
versely, community psychologys approach has generally been an
etic one in which models are developed in one context and applied
in another. However, unique aspects of particular communities
may mean that single approaches are not universally applicable.
Clearly, neither approach is incompatible with the other, and it is
more often the case that both emic- and etic-level explanations of
human behavior are complementary strategies. The integration of
the emic and etic approaches, as demonstrated in the articles in this
Special Section, allows community psychology to benefit from
multicultural psychology and vice versa, thus creating a broader
framework for clinical psychology.
The purpose of this Special Section is to address the underlying
conceptual issues in integrating multicultural and community psy-
chology within a common framework. Each of the articles ad-
dresses issues facing ethnic minority populations, including iden-
tification of risk and protective factors, obstacles to mental health
service use, and optimal treatment effectiveness. The integration of
etic and emic approaches distinguishes the research programs in

787
 788 SPECIAL SECTION: INTRODUCTION
these articles from others that have solely focused on universal or
culture-specific approaches.
The inspiration for this Special Section was the inaugural Sund-
berg Conference at the University of Oregon in 2001. The confer-
ence brought together researchers and theorists in both cultural and
community psychology to stimulate the growth and synergism in
the expansion of clinical and developmental psychology. The
conference was named in honor of Dr. Norman Sundberg, whose
long and distinguished career has been grounded in a creative
integration of clinical, community, and cross-cultural research
(Sundberg, 2004). The articles by Munoz and Mendelson (2005)
and by Martinez and Eddy (2005) are based on presentations at the
Sundberg Conference.
In their article in this Special Section, Hall, Teten, DeGarmo,
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
Sue, and Stephens (2005) develop a conceptual model of how emic
cultural variables interact with etic risk factors for sexual aggres-
sion. Hall et al. evaluate the risk factors identified in Malamuth,
Sockloskie, Koss, and Tanakas (1991) confluence model with
European American and Asian American samples. Although the
risk factors in the confluence model are applicable to both samples,
concern about loss of face attenuates these risk factors and serves
as a protective factor only among Asian Americans. Hall et al.
discuss both general and culture-specific considerations in inter-
ventions to prevent or reduce the risk of sexual aggression.
An ongoing dilemma in clinical psychology involves attracting
ethnic minorities to the mental health care system and providing
effective services after they seek treatment (Sue, 1998). Articles by
Duran et al. (2005); Halliday-Boykins, Schoenwald, and Letour-
neau (2005); and Yeh et al. (2005) address cultural and community
issues in mental health service use and effectiveness. The etic
conceptual framework for Duran et al.s research on American
Indian mental health use is the network-episode model (Pescoso-
lido & Boyer, 1999), which conceptualizes the likelihood of help
seeking as a function of the type of disorder, personal history with
the disorder, the social support system, and the treatment system.
Duran et al. report that the quality of the social support system is
associated with the desire to solve the problem without treatment,
perceived quality of mental health care, and communication be-
tween the health care provider and the patient. Theoretical and
practical implications at the individual, cultural (emic), commu-
nity, and organizational levels are discussed.
Halliday-Boykins et al. (2005), in the third article in this Special
Section, examine therapist caregiver ethnic matching in a study of
youths referred for multisystemic therapy, which targets factors in
the social ecology (family, peers, school, neighborhood, and com-
munity) that contribute to antisocial behavior. Youths whose care-
givers were ethnically matched with the therapists demonstrated
greater decreases in symptoms, longer times in treatment, and
increased likelihood of discharge for meeting treatment goals
relative to youths whose caregivers were not ethnically matched.
Thus, the effectiveness of an etic treatment model is enhanced by
ethnic matching, an emic variable.
Sue (1998) posited that it is not ethnic match per se that causes
positive treatment outcomes. Congruence between therapist and
clients beliefs and expectations of treatment, or cognitive match,
may underlie the positive effects of ethnic match. In the second
article in this Special Section, Yeh et al. (2005) examine cognitive
match regarding patient etiological beliefs in a multiethnic sample.
It was posited that biopsychosocial beliefs about the etiology of
problems would be associated with mental health services use,
whereas other etiological beliefs (e.g., sociological) would be
associated with not using mental health services. Yeh et al. report
that parents of Asian Pacific Islander Americans and Latino/a
Americans were less likely to have their children use mental health
services over a 2-year period than were European Americans.
These ethnic differences are accounted for by parental beliefs.
Asian Pacific Islander American and Latino/a American parental
beliefs that their childrens problems were the result of physical
causes or trauma (i.e., biopsychosocial beliefs) were positively
associated with service use, whereas Asian Pacific Islander Amer-
ican and Latino/a American parental beliefs that their childrens
problems were caused by relationship problems or prejudice (i.e.,
sociological beliefs) were negatively associated with service use.
Similar to Halliday-Boykins et al.s (2005) findings, an emic
variable ethnic-specific parental beliefsinfluences the effec-
tiveness of etic mental health services. These findings may inform
outreach, referral, and treatment efforts with ethnic minority
populations.
Another approach to increasing the effectiveness of mental
health services for ethnic minority groups is emic cultural adap-
tation of etic empirically supported treatments (Hall, 2001), which
is the focus of the first and final articles in this Special Section.
Empirical support for treatments with ethnic minority populations
is limited, and these approaches have primarily been evaluated in
controlled clinical settings rather than in the community. Critics
have argued that evidence of such cultural and community adap-
tations of empirically supported interventions is overstated (Elliott
& Mihalic, 2004).
The article by Martinez and Eddy (2005) is on the effects of
culturally adapted parent management training on Latino youth
behavior outcomes. Parent management training involves didactic
instruction, modeling, role playing, and home practice to teach
parenting skills in encouragement, monitoring, discipline, and
problem solving. The adaptation process included a consideration
of the conceptualtheoretical and operation relevance to Latino/as
for each of the existing components of the intervention and devel-
oping new culturally relevant content areas. At 5-month follow-up,
the intervention produced beneficial parent and youth outcomes in
a community sample of Latino/a families.
Munoz and Mendelson (2005) describe the adaptation of
cognitive behavioral therapy for Latino/as. The elements in this
adaptation included the following: (a) ethnic minority involvement
in intervention development; (b) cultural values; (c) religion and
spirituality; (d) acculturation; and (e) racism, prejudice, and dis-
crimination. The effectiveness of this adapted approach is reported
in multiple settings with multiple client populations.
In future clinical psychology research, multicultural and com-
munity contexts should be central considerations in the develop-
ment of conceptual models and interventions, rather than an after-
thought. As demonstrated in this Special Section, it cannot be
assumed that one size fits all when it comes to theory, research,
and interventions. The relevance of approaches for a particular
context should be carefully evaluated when the approaches have
been developed outside the particular context. Etic approaches
may often require emic tailoring for optimal use and effectiveness.
Clinical psychology needs to be relevant beyond the European
American individuals that have been most commonly studied. The
integration of culture and community contexts into clinical psy-
 SPECIAL SECTION: INTRODUCTION
chology is necessary for it to remain relevant in an increasingly
diverse 21st century.
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Received January 21, 2005
Revision received February 18, 2005
Accepted February 22, 2005