Psychotherapy Research With Ethnic Minorities Empirical, Ethical, and Conceptual Issues Gordon C. Nagayama Hall Department of Psychology The Pennsylvania State University ABSTRACT There is an increasing demand for psychotherapy among ethnic minority populations. Yet, there is not adequate evidence that empirically supported therapies (ESTs) are effective with ethnic minorities. Ethical guidelines suggest that psychotherapies be modified to become culturally appropriate for ethnic minority persons. Conceptual approaches have identified interdependence, spirituality, and discrimination as considerations for culturally sensitive therapy (CST). However, there is no more empirical support for the efficacy of CSTs than there is for the efficacy of ESTs with ethnic minority populations. The chasm between EST and CST research is a function of differences between methods and researchers in these 2 traditions. Specific recommendations for research collaboration between CST and EST researchers are offered. There is a need for psychotherapies for ethnic minority populations that are both empirically supported and culturally sensitive. One impetus for this demand is scientific. Inclusion of ethnic minority populations may help determine the external validity of psychotherapy research ( Hohmann & Parron, 1996 ; S. Sue, 1999 ). Psychotherapy efficacy should be investigated with ethnic minority groups to determine the generalizability of psychotherapy approaches (cf. Okazaki & Sue, 1995 ). For these reasons, the National Institutes of Health (NIH) in 1994 created a policy that requires the inclusion of ethnic minority persons in federally funded research ( Hohmann & Parron, 1996 ). Although there is increasing empirical support for several psychotherapies for certain disorders, there is not adequate empirical evidence that any of these empirically supported therapies (ESTs) is effective with ethnic minority populations ( Matt & Navarro, 1997 ; Miranda, 1996 ; S. Sue, 1998 , 1999 ). Thus, there is a need for psychotherapy efficacy research with ethnic minorities. A second impetus for psychotherapy research with ethnic minority populations is economic. Persons of color already are nearly 30% of the U.S. population, and census projections are that this will increase to 50% within 50 years. Many ethnic minority persons want psychotherapy services that are culturally sensitive ( S. Sue, Fujino, Hu, Takeuchi, & Zane, 1991 ). If such culturally sensitive therapies (CSTs) are not developed, many ethnic minorities may not seek psychotherapy services. Thus, monocultural psychotherapy would not reach what is a growing market for psychotherapy. CST involves the tailoring of psychotherapy to specific cultural contexts. Persons from one cultural group may require a form of psychotherapy that differs from psychotherapy for another cultural group. Moreover, there may be cultural variations among persons within a cultural group that require additional modification of psychotherapy interventions. Many models of CST have been developed (e.g., Betz & Fitzgerald, 1993 ; Ivey, Ivey, & Simek-Morgan, 1993 ; Ramirez, 1999 ; D. W. Sue, Ivey, & Pedersen, 1996 ). This is not to contend that context is irrelevant in EST approaches. Nevertheless, sociocultural contexts have yet to be adequately investigated in EST research. Journal of Consulting and Clinical Psychology © 2001 by the American Psychological Association June 2001 Vol. 69, No. 3, 502-510 For personal use only--not for distribution. Page 1 of 169/5/2001http://spider.apa.org/ftdocs/ccp/2001/june/ccp693502.htmlSimilar to ESTs, there is not a single culturally sensitive therapeutic approach. Rather, EST and CST represent two different orientations to therapy. There is a strong ethical and conceptual rationale for these culturally sensitive approaches. However, there is not adequate empirical support that culturally sensitive psychotherapies are efficacious with ethnic minority populations. Culturally sensitive psychotherapies must be empirically supported if they are to survive under the scrutiny of managed care (cf. Barlow, 1996 ; Beutler, 1998 ). In other words, CSTs have to become ESTs. There is sharp disagreement on how to develop efficacious psychotherapies for ethnic minority populations. Advocates of ESTs may consider their methods to be universally valid and may view the issue as one of simply applying ESTs, which have been demonstrated to be efficacious with European Americans, to ethnic minority groups. As mentioned above, there is not evidence that any EST is valid for ethnic minorities ( Matt & Navarro, 1997 ; Miranda, 1996 ; S. Sue, 1998 , 1999 ). Conversely, advocates of CSTs appreciate the importance of cultural mechanisms and have argued that simply exporting a method from one cultural group to another is inadequate. ESTs are CSTs for a particular ethnic minority group: European Americans (S. Sue, personal communication, January 2000). The purpose of this article is to present scientific, ethical, and conceptual rationales for why and how psychotherapy research should become more sensitive to multiple cultural groups. I also discuss why the EST and CST approaches have been at odds and propose that the two approaches may actually benefit one another. ESTs A major advance in psychological science has been the identification and development of ESTs. The Division of Clinical Psychology (Division 12) of the American Psychological Association (APA) Task Force on Promotion and Dissemination of Psychological Procedures was the culmination of these research efforts. A Special Section of the Journal of Consulting and Clinical Psychology (February 1998) was devoted to ESTs. ESTs are treatments that have been demonstrated to be superior in efficacy to a placebo or another treatment ( Chambless & Hollon, 1998 ). The criteria for well-established treatments are at least two good between-groups design experiments or 10 or more single-case design experiments by at least two different investigators demonstrating superiority to pill or psychological placebo or to another treatment, or equivalence to an already established treatment. Treatment manuals are required in the experiments, and client characteristics must be clearly specified. The criteria for probably efficacious treatments are two experiments showing the treatment is more effective than a waiting-list control group, one or more experiments meeting the well-established treatment criteria, or
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