Cultural sensitivity in clinical practice and training

Acquiring skills to work with culturally diverse populations is important in all facets of pediatric psychology.

By Anna Maria Patiño-Fernández, Monica Mitchell, PhD, and Elizabeth Pulgaron
Acquiring skills to work with culturally diverse populations continues to be increasingly important in all facets of pediatric psychology. This can be accomplished in a myriad of ways, including attending lectures, workshops, and webinars, seeking supervision/mentorship, and learning foundational theoretical information. Regarding the latter, numerous publications exist including the multicultural counseling competencies and standards proposed by Sue, Arredondo, and McDavis (1992). These standards speak to actions, attitudes, and knowledge that counselors must possess when working in an increasingly diverse society. Furthermore, a model for organizing and systematically considering complex cultural influences that need to be addressed in psychological intervention is the ADRESSING (Age and generational influences, Disability, Religion, Ethnicity, Social status, Sexual orientation, Indigenous heritage, National origin, and Gender) framework (Hays, 1996). This is a model for exploring patients’ cultural identities, as well as a guide for psychologists to examine their own biases and challenge their prejudices. This framework can also help us reflect on our own areas of inexperience in working with culturally diverse children and families.
Specifically, when conducting an intake with a new patient it is important to assess and determine which cultural factors are relevant to presenting problems and reassess the role of culture throughout the course of therapy. It is also necessary for psychologists to be self-aware- of their own cultural identities- and of how our own personal biases affect case conceptualization. In our research it is important to consider how our participants culture can influence recruitment, participation, and outcomes. Learning about our patients’ cultural background will facilitate all of our interventions.
What changes in training and practice need to take place for us to better serve our clients and inform our research? Hays, Dean, & Chang (2007) tackled this question by conducting semi-structured interviews and focus groups with counselors in training. We present several ideas from this qualitative research to begin a dialogue:
  • Acknowledging within-group differences for cultural groups. Many times individual differences are overlooked in an effort to understand the larger culture or as a short cut;
  • Educators, supervisors, and trainees must be willing to have an open dialogue about multicultural issues, especially “invisible” minority groups (e.g., gay, lesbian, bisexual, and transgender);
  • Diversity infused throughout curricula to provide a more integrated and comprehensive approach to training rather than having one class addressing multicultural issues;
  • Discussions of privilege and oppression in the classroom and supervision as it relates to the professor/supervisor can help students examine their views and biases but also serve to model for trainees how to begin to have these conversations;
  • Supervisors can create safe environments where students can explore their own beliefs and biases. Trainees may be unaware of their reactions to clients based on their cultural experiences, background, or bias. Open discussions of reactions to clients can be an important tool in supervision to facilitate multicultural counseling competency, examine personal reactions, clarify their values, and separate personal and professional reactions.
There is a bridge between training and practice that educators and supervisors should continue to fortify: What trainees learn in one arena influences the other. In addition, the connection between personal and clinical/research experiences demonstrates a need to bring these discussions more into the classroom and training settings.


Hays, P. A. (1996). Addressing the complexities of culture and gender in counseling. Journal of Counseling and Development, 74 , 332-338.
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 , 64-88.
Hays, D. G., Dean, J. K., & Chang, C. Y. (2007). Addressing Privilege and Oppression in Counselor Training and Practice: A Qualitative Analysis. Journal of Counseling & Development, 85 , 317-324 .