Cultural Bias

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[Theory] Explain ethnocentrism and how it can produce cultural bias in psychological research or clinical practice.

SUMMARY

Triandis (1990) defines ethnocentrism as judging what is natural or correct using the norms of one’s own ethnic or cultural group. The notes distinguish group self-centredness, outgroup negativity and ingroup positivity. Researchers may mistakenly treat their own norms as universal, misinterpret behaviour in other cultures or construct culturally inappropriate measurements. Clinicians might regard collectivist family relationships as dysfunctional if they assume Western independence is the standard of psychological health. This can affect interpretation, diagnosis and treatment.

ORIGINAL NOTES

• Ethnocentrism: Three broad major themes in these definitions emerged: (a) group self-centeredness (i.e., giving strong importance to one’s group), (b) outgroup negativity (i.e., hostility and contempt towards other groups), and (c) mere ingroup positivity (i.e., positive evaluation of one’s own group).

• Triandis (1990) defines it as the tendency to use one’s own ethnic or cultural group’s norms to decide what is “natural” and “correct” for everyone. This may be motivated by the belief that one’s own race, ethnic, or cultural group is the most important. Ethnocentrism can lead to incorrect assumptions about other people’s behavior, based only on one’s own norms and beliefs.

• Cultural relativism takes the opposite stance. It values a culture’s practices from that culture’s own point of view, rather than judging them by outside assumptions.

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[Theory] Explain cultural relativism as an approach to reducing cultural bias, with practical examples.

SUMMARY

Cultural relativism interprets practices from the perspective of the culture in which they occur, rather than imposing outside standards. In assessment, clinicians should consider whether an experience treated as pathological within one framework is interpreted differently in another; the notes suggest spiritual experiences and Māori worldviews as an example, but not as an automatic generalisation about all Māori. Clinicians should not assume collectivist family structures are dysfunctional. Respecting the client’s worldview may promote trust, psychological safety and treatment engagement.

ORIGINAL NOTES

• Cultural relativism takes the opposite stance. It values a culture’s practices from that culture’s own point of view, rather than judging them by outside assumptions.

• Cultural relativism: Ethnocentrism may take obvious forms, in which one consciously believes that one's people's arts are the most beautiful, values the most virtuous, and beliefs the most truthful.

• The principle is sometimes practiced to avoid cultural bias in research and to avoid judging another culture by the standards of one’s own culture. For this reason, cultural relativism has been considered an attempt to avoid ethnocentrism.

• Standardized psychological tests and diagnostic manuals (such as the DSM-5) were often normed primarily on Western, individualistic populations. Cultural relativism helps clinicians recognize that what appears "pathological" or "deviant" in a Western framework may be a normal, adaptive response or spiritual expression within another cultural group. For example, hearing voices and seeing things in Te Ao Māaori could be considered a gift as opposed to pathological behaviour

• Relativism strips away therapist bias, preventing practitioners from imposing their own moral, social, or familial norms (e.g., viewing collectivist family structures or arranged dynamics as inherently dysfunctional)

• Acknowledging that a client’s worldview is valid fosters psychological safety, reducing premature drop-out rates and stigma-driven reluctance

• Furthering the same logic, clinicians or researchers who have ethnocentric tendencies may risk pathologising societal norms from other cultures as deviant based upon the standards of their own. They risk viewing, for example, collectivised family structures as inherently a risk factor and dysfunctional, which may influence treatment

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[Theory] Compare emic and etic approaches and evaluate their advantages and risks.

SUMMARY

Etic approaches use external, potentially universal concepts or measures. Properly applied, they facilitate comparisons across cultures; imposed etics occur when culturally specific, often Western, assumptions are treated as universal, potentially missing local expressions of distress. Emic approaches examine behaviour through local language, meanings and categories, including culturally specific manifestations of psychological distress such as the notes’ Nepalese Jhum-Jhum example. They can improve cultural validity but make comparisons and generalisation across cultures more difficult. A sound approach distinguishes genuine universals from culturally particular findings.

ORIGINAL NOTES

• Etic Approach and Imposed Etics

• Looks at behavior from the outside using a global or universal framework. It assumes core psychological processes (such as basic emotions or symptoms of major depression) apply to all human beings)

• Similarly to the risks of ethnocentrism, using an etic approach could risk leading to an ethnocentric bias when studying cultures from the outside where Western-centric norms are misapplied to non-Western groups, thereby missing culture-specific expressions of distress or misdiagnosing norma behaviour as pathology, for example.

• However, when applied appropriately, it can be useful for creating cross-cultural comparisons

• Emic Approach

• Examines behavior from the inside using the specific meanings, language, and categories of the local culture.

• Clinicians focus on indigenous illness categories or culture-bound syndromes (e.g., somatic vs. psychologically-based expressions of distress where many cultures conceptualise psychological pain in terms of physical sensations such as Jhum-Jhum syndrome in Nepal: Tingling and numbness experienced as a physical manifestation of stress).

• However this, makes cross-cultural comparison difficult and can limit generalisability of psychological processes and therapeutic treatments to specific cultural contexts

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[Theory] Explain the WEIRD sampling problem and why it threatens generalisability.

SUMMARY

WEIRD means Western, Educated, Industrialised, Rich and Democratic. The notes state that such populations comprise about 12% of the world yet have supplied approximately 80–96% of psychological research samples; verify the precise statistics before the exam. When conclusions from narrow populations are universalised, researchers risk overlooking variation in culturally influenced psychological processes. Berry (1967) illustrates why an apparently general phenomenon, conformity, needs testing in contrasting cultural settings.

ORIGINAL NOTES

• W.E.I.R.D

• Western, Educated, Industrialised, Rich, Democratic; these are markers of a large amount of studies which mean that not all studies can be applied universally. 12% of world population but between 80-96% of psychological research is based on said sample.

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[Theory] Explain how cultural expectations might cause inappropriate psychiatric diagnosis.

SUMMARY

Diagnoses and standardised tests may be influenced by Western norms and reference populations. A clinician can misinterpret differences in speech, eye contact, emotional expression or relationships as signs of disorder rather than culturally normative behaviour. Schwartz et al. (2019) reported racial disparities in schizophrenia-spectrum diagnoses not matched by significant differences in certain clinician-rated symptoms. This is consistent with possible cultural insensitivity, but it does not establish that bias alone caused the diagnostic differences.

ORIGINAL NOTES

• Acknowledging that a client’s worldview is valid fosters psychological safety, reducing premature drop-out rates and stigma-driven reluctance

• The present study found that African Americans were diagnosed with a schizophrenia-spectrum diagnosis at a higher rate than White individuals, which was also evident in the rate of White individuals diagnosed with an affective disorder compared with African Americans. More important, no differences in symptoms were found

• It is worth noting that symptoms, particularly those involving negative and disorganized symptoms, are typically based on behavioral observations. Hence, they reflect a relatively narrow observational time and information frame. Diagnoses, on the other hand, reflect a global, overall impression, that includes multiple streams of information including behavioral observation but also historical information and collateral report

• Given that diagnosis and symptom ratings are inherently subjective and often inappropriately reflect overall, global impressions rather than an isolated channel of behavior (e.g., such as speech; Alpert, Shaw, Pouget, & Lim, 2002), it seems plausible that cultural insensitivity plays an important role in diagnostic biases. However, perhaps a fast and efficient diagnostic decision does not allow clinician’s to fully process normative cultural variations. This is an important issue, as the use of cultural sensitivity training could likely reduce this sort of bias

• cultural insensitivity, which may be defined as “Assigning a mental disorder diagnosis primarily influenced by personal perceptions of or stereotypes about consumers’ ethnicity or culture risks inadvertently harming consumers psychologically or socially through misdiagnosis”. Clinicians may fail to take into account true racial differences or use inappropriate norming or reference populations when evaluating patient signs and symptoms. That is, clinicians may misinterpret culturally normal behavior from patients as being pathological when they are unfamiliar with them. Indeed, the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM–5; American Psychiatric Association, 2013) cautions that disorganized speech, for example, may be difficult to assess because of linguistic style variations across people and suggests that clinicians be particularly sensitive to varying styles of emotional expression, eye contact, and body language

• First, we replicated previous literature suggesting diagnostic differences between racial groups. We failed to find group differences in current symptomatology.

• Additionally, regarding the behaviorally based measure of disorganization (CDI), African Americans were observed to have a higher rate of ambiguous word meanings, wrong word references, and grammatical unclarities. This difference was observed in a significant interaction between CDI and race, which suggested that higher levels of disorganization were more likely to lead to a schizophrenia-spectrum diagnosis, but only for African Americans.

• …highlighted the differences between what is commonly referred to as African American Vernacular English and African American English, compared with European American vernaculars, which highlights the idea that individuals use language differently

• In summary, it is unclear whether the observed CDI differences in the present study reflect normative variations observed in the sociolinguistic literature more generally.

• Objectively defined abnormalities in language and intonation were associated with increased rates of a schizophrenia-spectrum diagnosis in African Americans, but not increases in clinically rated disorganization or negative symptoms. Superficially, these data support the “cultural insensitivity” hypothesis of this study.

• We proposed that cultural insensitivity may play a role when clinicians fail to take into account true racial differences or use inappropriate norming or reference populations when evaluating patient signs and symptoms, though further research is needed to properly evaluate this.

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[Berry (1967)] Reconstruct Berry (1967) as a detailed study: rationale, hypothesis, groups, method, main findings and implication.

SUMMARY

Rationale: Barry, Child and Bacon (1959) proposed that high food-accumulating societies favour compliant, group-reliant socialisation, whereas low food-accumulating societies favour independence. Berry tested this using an Asch-like line judgement task. Groups: Temne rice farmers, Inuit hunting/fishing communities and Scottish comparison samples; traditional/transitional or rural/urban subgroups. Participants were shown a standard line and eight options and sometimes told which line most members of their cultural group chose. Temne participants accepted misleading group suggestions much more than Inuit participants; differences between cultures were significant at p < .01, while within-culture traditional/transitional differences were not. Implication: conformity varies across cultural/economic settings, challenging universal generalisation.

ORIGINAL NOTES

• Shows something that was thought as fundamental as conformity is actually culturally influenced

• Purpose: Barry, Child, and Bacon (1959) distinguished between low and high food-accumulating societies and suggested that to best meet their economic needs, in societies with low food accumulation (hunting or fishing peoples), "adults should tend to be individualistic, assertive and venturesome [p. 53]," while in societies with high food accumulation (pastoral or agricultural peoples), "adults should tend to be conscientious, compliant and conservative [p. 53]."

• However, no psychological instrument to gauge actual independence or conformity has yet been employed to discover if these differing types of subsistence economies with their concomitant socialization practices do, in fact, tend to produce individuals with opposing tendencies to accept group norms

• The Inuit world is void of edible vegetation; the people rely solely upon hunting and fishing for their livelihood and hence might be considered a good example of a low food-accumulating subsistence society… The Temne, on the other hand, are mostly rice farmers, harvesting a single crop each year which must then be meted out in daily units until the following harvest; they thus represent a high food-accumulating subsistence economy

• Hypothesis:

• It was considered that in an Asch (1956) type task members of these two societies would tend to accept the suggestion of the group norm to different extents; the Temne (who might be characterized as "group-reliant") should exhibit greater conformity than the more self-reliant Inuit.

• Secondly, it was considered that in the more traditional communities within each society, the suggestion of the group norm would be more effective than in those transitional, and generally less socially cohesive, areas.

• Methodologies

• Two samples were drawn from each society, one composed of traditional people without western education and one composed of people in transition to western life. In addition, two samples of Scots, one rural and the other urban, were selected as a reference group.

• Six test sheets, each with nine horizontal lines, were presented. A standard line was at the top and eight test lines of varying lengths were beneath it. On Sheet C, an X was placed beside Test Line 6 and the subject was told: Here is another sheet with nine lines on it, one here at the top, and eight beneath it. This time I am going to give you a hint. Most Temne (or Inuit, or Scottish) people say this line [experimenter pointed to number 6] is equal in length to the one at the top. Which one do you say?

• In this case, the designated line was actually the correct one. On Sheets D, E, and F, the same instructions were given as for Sheet C, but in each case the designated line was five lines away from the correct one. Over these three sheets the discrimination was eased, with D having 1 millimeter difference between the lengths of successive lines, E, 2 millimeters, and F, 3 millimeters.

• Results and Discussion

• The differences between the Temne and Inuit means are both significant beyond the .01 level (2=13.72 for the traditional samples, and 8.69 for the transitional samples). However, none of the differences between samples within each culture (transitional vs traditional) reaches significance (t = 0.65 for the Temne, 0.93 for the Inuit, and 0.24 for the Scots).

• Both traditional and transitional Temne samples show a highly significant tendency to accept the suggestion of the group norm, while the Inuit almost disregard it.

• Although all three rural/traditional samples show a greater tendency to accept the suggestion of the group norm than their urban/transitional counterparts, none of these differences is significant.

• It is apparent then, that the Temne and Inuit societies have been able to produce the degree of conformity required by their respective subsistence-level economies, and that for these two societies at least, the Barry et al. predictions have been confirmed by the application of a psychological measure. It thus may be concluded that low foodaccumulating societies do tend to produce individuals who are independent and self-reliant, while high food-accumulating societies tend to produce more dependent and group-reliant members.

• This tendency, furthermore, is carried into the transitional period (where economic life is no longer at a subsistence level), thereby demonstrating the persistence of psychological and cultural patterns in the absence of their ecological origins

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[Berry (1967)] Explain the ecological/socialisation rationale and Berry’s two hypotheses.

SUMMARY

The earlier subsistence theory suggested that farming systems requiring stored food and coordination encourage conscientiousness and conformity, while hunting/fishing economies requiring individual initiative encourage independence. The Temne grew and stored rice and represented higher food accumulation; Inuit communities relied on hunting/fishing and represented lower food accumulation. Berry hypothesised that Temne participants would accept the suggested group norm more than Inuit participants and that more traditional participants within each culture would conform more than transitional/urban participants.

ORIGINAL NOTES

• Hypothesis:

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[Berry (1967)] Describe Berry’s participants and why each comparison was included.

SUMMARY

Two Temne samples and two Inuit samples were drawn: traditional people without Western education and people transitioning towards Western life. Two Scottish reference samples, one rural and one urban, were also included. Temne and Inuit populations represented contrasting subsistence and socialisation patterns, while traditional/transitional and rural/urban comparisons tested whether degree of modernisation/social cohesion altered reliance on the group norm.

ORIGINAL NOTES

• Methodologies

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[Berry (1967)] Describe the line-judgement task precisely enough for an exam paragraph.

SUMMARY

Six sheets each contained a standard line at the top and eight candidate comparison lines below. On sheet C, an X marked a genuinely correct answer; participants were told most members of their own group selected that line. On D, E and F, the suggested group answer was five positions away from the correct line, creating a misleading norm. The lines varied by 1 mm, 2 mm and 3 mm respectively as discrimination became easier. The dependent measure concerned participants’ acceptance of the group suggestion in their judgements.

ORIGINAL NOTES

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[Berry (1967)] State Berry’s main statistical findings and distinguish supported from unsupported hypotheses.

SUMMARY

Temne versus Inuit means differed significantly at p < .01 in both traditional and transitional samples (reported statistics 13.72 and 8.69 in the notes). Both Temne groups accepted the suggested norm much more than the Inuit groups. Traditional/rural groups showed a numerical tendency to conform more than transitional/urban groups, but none of these within-culture comparisons reached statistical significance (Temne t = 0.65, Inuit t = 0.93, Scots t = 0.24). Therefore cultural-group variation was supported; the prediction of a meaningful traditional/transitional difference was not established.

ORIGINAL NOTES

• Results and Discussion

• Both traditional and transitional Temne samples show a highly significant tendency to accept the suggestion of the group norm, while the Inuit almost disregard it.

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[Berry (1967)] Explain Berry’s interpretation and the significance of persistence after transition.

SUMMARY

The results were consistent with the idea that economically functional socialisation produces different degrees of conformity. Temne agricultural life may favour group reliance, while Inuit hunting/fishing life may favour independence. The broad between-society pattern persisted among participants in transitional settings even after the original subsistence conditions had altered, suggesting psychological/cultural patterns can persist beyond their ecological origins. Avoid concluding that economy alone definitively caused the differences.

ORIGINAL NOTES

• Both traditional and transitional Temne samples show a highly significant tendency to accept the suggestion of the group norm, while the Inuit almost disregard it.

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[Berry (1967)] Use Berry (1967) to justify broader cross-cultural sampling and replication.

SUMMARY

Berry found pronounced Temne–Inuit variation in conformity using a comparable task. A psychologist studying only a Western or otherwise narrow population could mistakenly assume that a local pattern is universal. Recruiting across contrasting cultures, including non-Western and less represented populations, and replicating studies can establish whether an effect generalises. Where this is impossible, findings should be qualified as applying to the populations tested. Note that cross-cultural tasks themselves require validation to avoid imposed etics.

ORIGINAL NOTES

• W.E.I.R.D

• Expanding beyond WEIRD samples: use the statistics of WEIRD and also the Berry (1967) Independence and Conformity in Subsistence-level Societies to demonstrate why. Include non-western and developing populations and if possible investigate replications in other samples

• Otherwise, caution against (2nd solution) making universal generalisations beyond the sample

• Both traditional and transitional Temne samples show a highly significant tendency to accept the suggestion of the group norm, while the Inuit almost disregard it.

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[Griner & Smith (2006)] Reconstruct Griner and Smith (2006): purpose, design, cultural adaptations, results, implications and caveats.

SUMMARY

Purpose: test the empirical effectiveness of culturally adapted mental health treatment, addressing psychotherapy’s Western individualistic assumptions. Method: meta-analysis of 76 studies; 82% used experimental or quasi-experimental designs, while 14 relied on a single intervention group without controls. Adaptations included cultural values (84%), ethnicity matching (61%), language matching (74%), and culturally knowledgeable consultation (38%). Across 76 studies, mean random-effects d = .45 (95% CI .36–.53); across 62 experimental/quasi-experimental studies d = .40. Results broadly support cultural adaptation, but designs varied and associations for particular adaptations do not necessarily prove causation.

ORIGINAL NOTES

• Purpose: In short, although psychologists may believe that it is beneficial to adapt mental health interventions to meet clients’ needs, they may also believe that there is currently little empirical justification (with rigorous evaluations of effectiveness) for doing so. As a result, they may do very little to modify their practices.

• Why: Even with increasing acknowledgment of multicultural issues, contemporary psychotherapy continues to reflect the values of Western culture, most notably a persistent bias toward individualism. Collectivistic values and contextual circumstances are often ignored or minimized.

• Results

• The majority (82%) of research studies included in this meta-analysis involved experimental or quasi-experimental research designs. However, 14 studies reported data from a single intervention group without comparing outcomes to a control group (e.g., pre to posttest differences).

• The studies included in this meta-analysis involved several different types of outcome measures (i.e., mental health symptoms, client retention, client satisfaction)

• The most frequently mentioned cultural adaptations (84% of all studies) involved explicitly including cultural values/concepts into the intervention. In addition, many of the interventions attempted to match clients to therapists of the same ethnic group (61%) and native language if other than English (74%). In at least 41% of the reports, the clinic or organization providing the mental health intervention explicitly served clients from culturally diverse backgrounds. Several studies also included explicit collaboration/consultation with individuals familiar with the clients’ culture (38%), outreach efforts to recruit underserved clients (29%), provision of extra services designed to increase client retention (24%) such as child care during sessions, oral administration of written materials for illiterate clients (21%), cultural sensitivity training for professional staff (17%), and referrals to additional service agencies (15%).

• Across all 76 studies, the random effects weighted average effect size was d .45 (SE .04, p .0001), with a 95% confidence interval of d .36 to d .53. The data consisted of 72 nonzero effect sizes, of which 68 (94%) were positive and 4 (6%) were negative. Effect sizes ranged from d .48 to d 2.7.

• Discussion

• The results of this meta-analysis demonstrated an overall positive effect of culturally adapted mental health interventions. Across all 76 studies the random effects weighted average effect size was d .45, and across 62 studies with experimental or quasi-experimental designs, it was d .40.

• Given that previous psychotherapy outcome research has demonstrated very minimal differences (omg this was the Dodo bird study, so it’s saying that differences between traditional forms of psychotherapy), typically ranging from d 0 to d .21 (Wampold et al., 1997), across various forms of psychotherapy (e.g., cognitive vs. psychodynamic vs. humanistic) the results presented here are noteworthy. Overall, culturally adapted interventions resulted in significant client improvements across a variety of conditions and outcome measures

• Limitation/solution (so cultural adaptions should be targeted towards a single group of people): An important finding in the present metaanalysis concerned the racial composition of the participants. Interventions provided with groups of same-race participants (d .49) were four times more effective than interventions provided to groups consisting of mixed-race participants (d .12). This finding implies that cultural adaptations to mental health interventions may be more efficacious when the adaptations are specific to a particular racial/ethnic group. Multicultural adaptations designed to be sensitive to many cultural groups are still more efficacious than interventions without any cultural adaptations, but optimal benefit is apparently derived when the treatment is tailored to a specific cultural context

• Additional information for target demographics: studies with participants of higher chronological age and with higher percentages of Hispanic/Latino(a) participants had effect sizes of greater magnitude

• One possible explanation for these results relates to the acculturation level of the participants. Older populations tend to be less acculturated (and therefore possibly in greater need of cultural adaptations to psychotherapy) than younger populations, and Hispanic/Latino(a) populations are highly likely to speak Spanish, be migrants, and remain in lower socioeconomic status years after migration

• studies in which the client was matched with a therapist based on language (if other than English) had outcomes that were twice as effective as studies that did not. This finding strongly supports the need for therapeutic interventions to be conducted in clients’ preferred language.

• Limitation: Studies in which clients were not apparently matched to therapists based on ethnicity had average effect sizes that were higher than studies in which ethnic matching was generally attempted but not consistently conducted… the result found in our metaanalysis was in the opposite direction of that typically expected.

• This may be partly due to intracultural or intraethnic heterogeneity within participating populations. Simply being part of the same ethnic group may not indicate a common understanding

• Explanations why solutions work: Contemporary psychotherapy outcome research highlights the salience of common factors, such as the level of client trust and the quality of the therapeutic relationship, much more than specific modifications to psychotherapy content or method of delivery (e.g., Wampold, 2001; Wampold et al., 1997). Applying this line of reasoning to our findings, it is possible that the positive client outcomes associated with culturally adapted mental health interventions in this meta-analysis may be more related to clients’ increased sense of trust (and decreased concerns about institutional racism) than to the adaptations themselves.

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[Griner & Smith (2006)] Explain why Griner and Smith considered culturally adapted psychotherapy necessary.

SUMMARY

The authors noted that psychotherapy may reflect Western values, especially individualism, and overlook collectivist norms and clients’ circumstances. Clinicians may endorse tailoring care but hesitate without evidence of effectiveness. Adaptations seek to align treatment with clients’ language, cultural meanings and values, improve access and engagement, and address mismatch between psychological practice and clients’ expectations.

ORIGINAL NOTES

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[Griner & Smith (2006)] Give detailed examples of cultural adaptations described in Griner and Smith’s review.

SUMMARY

The notes list explicit incorporation of cultural values (84% of studies), therapist-client ethnic matching (61%) and native-language matching (74%), services dedicated to culturally diverse clients (at least 41%), consultation with culturally knowledgeable people (38%), targeted outreach (29%), retention support such as childcare (24%), oral delivery of written materials (21%), staff sensitivity training (17%) and referral to other agencies (15%). These are reported intervention features, not proof that each component independently caused improvements.

ORIGINAL NOTES

• Recommendations as outlined in literature (omg gives so many solutions that I could list and then say these were the overall result of culturally adapted interventions)

• First, scholars emphasize the need to explicitly incorporate the cultural values of the client into therapy. Clients of color are more likely to seek out and use mental health services when their values and beliefs are congruent with the interventions provided

• Second, to facilitate client perceptions of therapists’ understanding and similarity, clients can be matched with therapists of the same race/ ethnicity who speak the same native language (Coleman et al., 1995; Lam & Sue, 2001). Although there are confounding variables that need to be considered, research has shown that when compared to nonmatched clients, clients matched to therapists by native language and ethnicity are less likely to drop out prematurely from therapy and more likely to report satisfaction with the interventions provided (Campbell & Alexander, 2002; S. Sue, 1998).

• Third, mental health interventions and systems should be easily accessible and targeted to clients’ circumstances (Flaskerud, 1986; Zane et al., 1994). Whenever possible, services should be delivered within the community where clients reside (Uba, 1982). Optimally, the mental health services should be specifically designed for the local context. For example, Asian American clients who attended clinics specifically designed for Asian Americans living in ethnic neighborhoods of Los Angeles had better outcomes than those who attended mainstream mental health clinics (Yeh, Takeuchi, & Sue, 1994)

• Fourth, mental health practitioners should cooperate with support resources available within clients’ community, spiritual traditions, and extended family (e.g., Armengol, 1999; JacksonGilfort et al., 2001; Prizzia & Mokuah, 1991). For example, when Latina mothers were explicitly involved in the treatment of their children through recounting cultural folk stories, the children showed significant reductions in presenting symptoms compared to traditional therapy even after one year of follow-up (Costantino, Malgady, & Rogler, 1986)

• The studies included in this meta-analysis involved several different types of outcome measures (i.e., mental health symptoms, client retention, client satisfaction)

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[Griner & Smith (2006)] Give the headline outcome statistics and explain why the authors considered them notable.

SUMMARY

Across 76 studies, the random-effects weighted average was d = .45, SE = .04, p < .0001 and 95% CI approximately .36–.53. Among 62 experimental or quasi-experimental studies, d = .40. Of 72 non-zero effect sizes, 68 were positive and four negative. The notes contrast this with relatively small differences between established psychotherapies (d around 0–.21 in the cited literature). Interpretation: culturally adapted interventions were associated with meaningful improvements across varied outcomes.

ORIGINAL NOTES

• Results

• The studies included in this meta-analysis involved several different types of outcome measures (i.e., mental health symptoms, client retention, client satisfaction)

• Discussion

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[Griner & Smith (2006)] Explain the findings about adaptations targeted to specific ethnic groups.

SUMMARY

Interventions with same-race groups had a mean effect size of d = .49, compared with d = .12 for mixed-race groups, an approximately fourfold difference in the reported effect-size magnitude. The authors suggested culturally specific tailoring may work better than one generic multicultural adaptation. However, this is a comparison across studies, not a clean randomised test of the effect of group composition or adaptation specificity.

ORIGINAL NOTES

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[Griner & Smith (2006)] Discuss potential solutions + limitations and explanations

ORIGINAL NOTES

• This may be partly due to intracultural or intraethnic heterogeneity within participating populations. Simply being part of the same ethnic group may not indicate a common understanding

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[Griner & Smith (2006)] Evaluate therapist-client ethnic matching, including the contradictory finding.

SUMMARY

Although ethnic matching is often proposed to increase perceived similarity and trust, the meta-analysis reported higher average effects when therapists were apparently not ethnicity-matched than when matching was attempted but inconsistent. Shared ethnicity does not guarantee shared values or experience because of within-group heterogeneity. Professional training may also distance clinicians from culturally familiar practices. Matching is not sufficient by itself; individualised cultural competence and attention to preferences are essential.

ORIGINAL NOTES

• This may be partly due to intracultural or intraethnic heterogeneity within participating populations. Simply being part of the same ethnic group may not indicate a common understanding

• It is worth noting, however, that the mere fact that a clinician and patient share some background (or a researcher on a team) may not guarantee culturally appropriate care because in the course of professional training some clinicians may distance themselves from or devalue the tacit cultural knowledge they once had.

• For many smaller migrant groups, and in settings of extreme cultural diversity, such ethnic matching is not feasible because clinicians with the requisite linguistic and cultural background are not available. In this context, it is essential for clinicians to develop generic cultural competence. The basis of any general ability to work with people from diverse cultural backgrounds begins with the clinician’s knowledge of their own ethnocultural identity and the implicit biases this brings

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[Griner & Smith (2006)] Explain therapeutic trust as a possible mechanism for successful cultural adaptation.

SUMMARY

The notes emphasise common therapeutic factors, including client trust and strength of the therapeutic relationship. Cultural adaptations may improve outcomes because clients feel understood, face less fear of discrimination and are more willing to engage or remain in treatment. This may matter as much as the specific adapted intervention content. Present this as a plausible explanation advanced by the authors, rather than a mechanism conclusively isolated by their meta-analysis.

ORIGINAL NOTES

• This may be partly due to intracultural or intraethnic heterogeneity within participating populations. Simply being part of the same ethnic group may not indicate a common understanding

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[Griner & Smith (2006)] What demographic moderators and interpretative cautions appear in the notes?

SUMMARY

Studies with older participants and higher proportions of Hispanic/Latino participants had larger reported effect sizes. The authors considered acculturation and preferred language as possible explanations. The notes describe these as hypotheses, not proven causal explanations; broad assumptions about any ethnic group should be avoided. Variation in research designs and measures also complicates comparisons.

ORIGINAL NOTES

• This may be partly due to intracultural or intraethnic heterogeneity within participating populations. Simply being part of the same ethnic group may not indicate a common understanding

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[Griner & Smith (2006)] Explain why treatment should engage family and other cultural support resources.

SUMMARY

The notes report recommendations to involve extended family, spiritual resources and local networks where appropriate, and to tailor provision to clients’ circumstances. One cited example involved Latina mothers telling culturally familiar folk stories in their children’s treatment, with reported symptom reductions compared with traditional therapy at one-year follow-up. The general reasoning is that treatment can become more acceptable and relevant when it takes the client’s relational and cultural context seriously.

ORIGINAL NOTES

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[Meihana / Māori models] Explain the intended purpose of the Meihana model and its contrast with narrow Western assessment.

SUMMARY

The notes discuss using a practical clinical model informed by Te Whare Tapa Whā and a relational, holistic Māori conception of wellbeing. Rather than treating assessment as solely an encounter between an isolated patient and clinician, it considers relationships, physical wellbeing, spirituality, environment and organisational context. The model aims to make culturally appropriate assessment actionable. IMPORTANT SOURCE NOTE: these passages concern the Meihana model; the document labels the section Rangihuna et al. (2019), “Mahi a Atua”. Verify attribution before citing as one study.

ORIGINAL NOTES

• Purpose: This model developed from a desire to implement Te Whare Tapa Wha within psychological practice with the primary aim being to provide a set of guidelines easily applied in clinical settings.

• Psychological practice is usefully guided by frameworks that can be applied to individual circumstances and that are inclusive of individual differences. The Meihana model, however, highlights that the assessment/intervention is not limited to the interaction between the clinician and the client. It is instead a combination of multiple relationships that occur within a larger system.

• (Durie 1985) A Maori Perspective of Health A characteristic of Western thinking is its analytical capacity. The whole is quickly dissected into its component parts so that greater understanding might occur. Individual properties are used to distinguish one object from another, one person from another. By contrast, Maori thinking could be described as holistic. Understanding occurs less by division into smaller and smaller parts, than by synthesis into a wider, contextual system. Consistent with this style of thinking, health is viewed as an inter-related phenomenon rather than an intrapersonal one.

• (Durie 1985) A Maori Perspective of Health Healthy thinking, in Maori terms, is integrative not analytical. The individual whose first thoughts are for himself, his personal ambitions or his own body is considered unhealthy, even though his body may be the epitome of fitness.

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[Meihana / Māori models] Reconstruct the development and piloting process described for the Meihana model.

SUMMARY

The notes describe a literature review and interviews with Māori and non-Māori practitioners, including psychologists, GPs, nurses and social workers. Clinicians knew principles of Te Whare Tapa Whā but often struggled to apply them in practice. The developing model was piloted over five years by two psychologists, a nurse and a GP, with practitioner discussion and feedback informing refinement. The notes also mention teaching use with paper cases and Māori patient clinical interviews. Verify which original publication reports each part before attributing.

ORIGINAL NOTES

• Limitations for Any Solutions

• To adequately implement the Mehiana Model requires adequate professional development and support provided to clinicians and researchers; however, this requires a large existing body of educators who are culturally competent and capable of communicating this knowledge, which we currently lack–could turn into solution with greater training

• It was reported that “Within a teaching context the Meihana model was seen as ‘engaging and practical,’ with students showing an ability to apply the model to paper cases and clinical interviews conducted for a specific Hauora Māori patient assignment”

• Methods

• Standard literature review, interviewed Māori and non-Māori health clinicians including psychologists, GPs, nurses, social workers. They were asked how they were implementing Te Whare Tapa Wha within their practice.

• It became clear from these interviews that while these clinicians were familiar with the core principles they often struggled to put the model into practice within their clinical settings.

• The developed model was then piloted by two psychologists, one nurse, and one GP over 5 years. Discussions between clinicians provided feedback for the Meihana Model in clinical settings

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[Meihana / Māori models] Explain the risk of “de-Māorifying” a Māori health model.

SUMMARY

The notes say that clinicians sometimes labelled a holistic framework simply “best practice”, erasing its Māori foundations. They then applied a generic cultural checklist to all minority clients, defaulting to dominant-culture assumptions and ignoring each person’s specific needs. The proposed response is substantive cultural safety and competence, not superficial adoption of Māori terminology. Clinicians should understand the cultural meaning of the model and adapt their process to the individual client.

ORIGINAL NOTES

• Results

• It was found that often the integration of a holistic model such as Te Whare Tapa Wha lead to assertions of this being just ‘best practice.’ This discourse ‘de-Māorified’ key Māori beliefs, values and experiences. In this context clinicians assumed that if they work within a ‘safe framework’ they could utilise the same cultural check list on any of their ethnic minority clients. This in turn tended to lead to a default to predominant culture assumptions and expectations, with little if any real consideration of clients’ specifi c cultural needs and wants.

• The Meihana model has the prerequisite that clinicians who utilise it have a clear understanding of cultural safety and cultural competency, and are able to demonstrate abilities within both of these areas with regards to Māori

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[Meihana / Māori models] Explain whānau in the Meihana model, including how services should respond.

SUMMARY

Whānau concerns the client’s support relationships and their place in assessment, treatment and monitoring. Services should create policies and physical space for participation without isolating the client, allow the client/whānau to decide their desired degree of involvement, and seek feedback on cultural safety. The notes contrast this with approaches that automatically equate psychological maturity with independence from family.

ORIGINAL NOTES

• Dimension: Whanau

• Definition: Client support networks.

• Rationale: Whanau are seen as having a key role in the assessment, intervention and monitoring process of the client/whanau.

• Relationship to Service: Policies are needed to support the engagement of client without isolating whanau (Ministry Of Health 2001; Durie

• 2001). This involves including whanau within the assessment and intervention processes, and having space that allows this within clinical settings. Whanau should have the opportunity to identify what level of integration of Mãori cultural input they want to engage in and to give feedback to services about their perceived level of cultural safety and competency.

• (Durie 1985) A Maori Perspective of Health This family-oriented approach with its tendency to foster a group (rather than individual) identity [16] stands in contrast to the Western attitude to maturity and good health where an independent lifestyle is often equated with good mental health and where emphasis is given to self assertion, lack of dependence on parents and the elimination of the generation gap. To be a total person however, 'in one's own right' is, from a Maori perspective, to be in an unhealthy state. The individual has no validity of his own. While his personal talents may be considerable, an insistence on independence is regarded as immaturity, and an inability to depend on the family, is seen as unnecessarily defensive. It is in this area that many counselling and therapeutic approaches within the mental health field have little credibility in Maori eyes.

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[Meihana / Māori models] Explain tinana and hinengaro as components of culturally responsive assessment.

SUMMARY

Tinana concerns physical wellbeing and its connection to psychological wellbeing; care should not separate them artificially. Hinengaro concerns thoughts, feelings and the mind-body relationship. Assessment tools, diagnostic interpretations and intervention plans should be examined in their cultural context. Services should offer supervision and guidelines to prevent measurement or interpretation from defaulting to inappropriate Western norms.

ORIGINAL NOTES

• Dimension: Tinana

• Definition: Working to promote physical well-being of client/whanau.

• Rationale: To ensure that the service encompasses the importance of physical well-being and its relationship to overall psychological well-being.

• Dimension: Hinengaro

• Definition: Covers thoughts, feelings, the mind-body connection, and how you process information and express

• Rationale: To ensure cultural accountability of measures used to provide evidence that supports or challenges hypotheses around the presenting behaviours.

• Relationship to Service: All assessment tools and diagnosis processes need to be placed within the appropriate cultural context to ensure valid hypotheses are drawn and that potential interventions sit within appropriate cultural norms. Services may develop practice guidelines or supervision modules that highlight potential biases or barriers when working with Māori (Ogden, Cooper & Dudley, 2003). Policies and resources need to be developed that support clinicians to engage in appropriate supervision to ensure that the analysis of the assessment data is matched to Māori beliefs, values and experiences.

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[Meihana / Māori models] Explain wairua, including why Western clinical approaches may overlook it.

SUMMARY

Wairua concerns spiritual identity, values, faith, traditions, ancestors and connectedness. The notes state that some clinicians omit this domain because they feel unqualified or regard it as somebody else’s role. The model encourages services to support appropriate consideration of this dimension so that assessment and treatment respect Māori values and experiences.

ORIGINAL NOTES

• Dimension: Wairua

• Definition: Level of attachment to identity, values, faith, tradition, ancestors, etc.

• Rationale: To investigate factors that contribute to engagement and therefore the level of attachment the client/whanau feel to the service and the services being provided at a more general level.

• Relationship to Service: Traditionally neglected by clinicians who consider that they do not have competencies to work in this area, or see it is the role of others to investigate this realm. However within the Meihana model all dimensions need to be explored to ensure effective service delivery that is responsive to Māori beliefs, values and experiences. This requires explicit support and resources to enable workers to extend beyond the potentially limited focus of western paradigms.

• Solution: These is earthly/ grounding attachment in terms of another person(s), thing and/or a place that is seen by the client as someone, something or where they feel they belong and are supported by for example a parent or close friend, a soft blanket or toy (especially with children), a home in which they felt safe, a place where they feel at peace. In risk assessments the absence of such a connection may indicate a higher risk for self-harm behaviour.

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[Meihana / Māori models] Explain taiao and iwi-katoa, including concrete implications for services.

SUMMARY

Taiao concerns the service’s physical environment and its acceptability/accessibility. Māori language, signage, staff presence and recruitment practices can affect whether whānau feel welcomed. Iwi-katoa concerns societal and organisational structures: clinicians must recognise that their own social realities differ from clients’ and inspect policies, processes and institutional culture for obstacles to equitable engagement and retention.

ORIGINAL NOTES

• Dimension: Taio

• Definition: The physical environment of the services.

• Rationale: Ensuring physical accessibility and acceptability of the service.

• Relationship to Service: The lack of Mãori mediums (e.g. posters, signage) within the organisation or the visible lack of Mãori staff may not support client/whanau in engaging with the service. Services need to develop policies around the pro-active recruitment of Mãori staff/clinicians (Herbert 2002, Robertson, Haitana, Pitama & Huriwai 2006) and clear recruitment process and interview procedures to make this process transparent. Advice and guidance should be sought as necessary to increase the attractiveness of the services to Mãori stakeholders (client/whanau/provider groups).

• Dimension: Iwi-Katoa

• Definition: Societal structures that impact on the capacity of the organisation to work alongside client/ whanau.

• Rationale: To identify current organisational strengths and weaknesses to work effectively with Maori client/ whanau.

• Relationship to Service: This dimension challenges the clinician to be reflective that their own social reality may be quite different from that of Mãori client/whanau and how that might constrain effective delivery of processes and protocols within the service (Harris, Tobias, Jefferys, Waldegrave, Karlsen & Nazroo, 2006).

• Iwi Katoa encourages services to look at the impact that service policies, processes and culture have on retaining and providing appropriate services to Mãori clients/whanau (Ministry of' Health 2002).

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[Meihana / Māori models] Use Durie (1985) to explain how holistic Māori concepts challenge individualistic assumptions.

SUMMARY

The notes contrast an analytic Western tendency to divide problems into isolated parts with a Māori emphasis on relationships and holistic context. Health is presented as interrelated rather than purely intrapersonal; whānau connection can be central to wellbeing. A clinician who equates autonomy, individual assertiveness or separation from family with psychological health could misinterpret a relationally oriented client. Avoid claiming all Western or all Māori people share identical beliefs.

ORIGINAL NOTES

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[Meihana / Māori models] Evaluate practical barriers to implementing culturally grounded models such as Meihana.

SUMMARY

Practitioners need cultural safety, cultural competence, training, suitable supervision and institutional support to use the model appropriately. The notes suggest a shortage of educators with the necessary expertise and report that clinicians often recognised Te Whare Tapa Whā but struggled with application. Without training, a model risks becoming a superficial checklist or being generalised beyond its intended context. Implementation therefore requires both staff development and structural support.

ORIGINAL NOTES

• Limitations for Any Solutions

• Results

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[Schwartz (2019)] Reconstruct Schwartz et al. (2019): aims, participants, measures, findings and significance.

SUMMARY

Aim: examine racial variation in schizophrenia-spectrum diagnosis and whether objective speech disorganisation or clinician-rated symptoms accounted for differences. Sample: 251 participants. Method: recorded semi-structured conversations about daily life, hobbies and interests; psychiatric symptom ratings using BPRS informed by several clinical sources, and a behavioural communication-disorganisation measure (CDI). Findings: roughly 83% of African American versus 63% of White participants received schizophrenia diagnoses; 14% versus 33% received affective-disorder diagnoses. No significant racial difference appeared in some clinician-rated disorganisation/negative-symptom scores, while CDI scores differed. Racial interactions and diagnostic disparities were consistent with possible cultural insensitivity, but causation was not established.

ORIGINAL NOTES

• The study aimed to replicate previous findings indicating African Americans received a diagnosis pertaining to schizophrenia-spectrum disorders at a higher rate compared with White individuals and to examine whether they exhibited more severe disorganisation in speech as rated by clinicians. They further aimed to examine whether there were objective differences between groups in terms of disorganised symptoms and to determine whether such objective measurements of pathology moderated the relationship between race and clinician symptom rating and/or diagnosis. This last aim evaluated whether clinicians may be subtly influenced by linguistic style variations that may lead to a diagnosis of schizophrenia and/or related symptoms in African Americans but not in White individuals.

• Methodologies

• 251 participants.

• Research assistants engaged the subject in recorded semistructured conversations about daily activities, hobbies, and interests.

• The Brief Psychiatric Rating Scale was used to characterize psychiatric symptoms. BPRS ratings were based on information obtained from medical records, the patients’ treatment teams, self-report, and behavioral observations made during the research interview

• Results

• The present study replicated previous findings of a diagnostic difference of Schizophrenia in African Americans compared with White individuals (see Figure 1). Approximately 83% of African Americans were given a diagnosis of Schizophrenia, compared with 63% of White individuals, and only 14% of African Americans were diagnosed with an affective disorder compared with 33% of White individuals. This difference was statistically significant. There were no statistically significant differences between African Americans and White individuals on clinician-rated BPRS scores of conceptual disorganization or negative symptoms

• In regards to the second aim, there were statistically significant differences between African Americans and White individuals on the total CDI score, t(237) 2.94, p .004, suggesting that African Americans showed more communication disturbance in their speech compared with their White counterparts. (objective measurement)

• A visual inspection of this interaction suggested that African Americans, but not White individuals, were rated as more disorganized by clinicians at low levels of emphasis compared with at high levels of emphasis (see Figure 2)

• Disorganization, as measured by the CDI, demonstrated a significant interaction between CDI and race, though race alone was observed as the strongest predictor of diagnosis; indicating that African Americans were 3.7 times more likely to be diagnosed with schizophrenia. The results demonstrated that at higher levels of disorganization, African Americans were more likely to be diagnosed with schizophrenia compared with White individuals. In relation to acoustic variables, the interaction between intonation and race was significant, though race alone was observed to best predict diagnosis; such that African Americans were 2.9 times more likely to be diagnosed with schizophrenia.

• Discussion

• First, we replicated previous literature suggesting diagnostic differences between racial groups. We failed to find group differences in current symptomatology.

• In summary, it is unclear whether the observed CDI differences in the present study reflect normative variations observed in the sociolinguistic literature more generally.

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[Schwartz (2019)] Explain the research aims and why behaviour-based measures were included.

SUMMARY

The study aimed to replicate earlier evidence of higher schizophrenia-spectrum diagnosis rates among African American than White patients, test whether clinician-rated speech disorganisation differed, and determine whether behaviour-based communication measures could explain or modify diagnosis patterns. Since clinical ratings can reflect subjective interpretation, recordings and CDI measurements offered another way to examine speech and possible linguistic variation.

ORIGINAL NOTES

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[Schwartz (2019)] Describe Schwartz’s methodology and distinguish CDI from BPRS.

SUMMARY

Researchers interviewed 251 participants in recorded, semi-structured conversations on daily activities, hobbies and interests. The Brief Psychiatric Rating Scale (BPRS) described clinical symptoms using medical records, treatment-team information, patient self-report and observations during interview. The CDI measured aspects of communication disorganisation, including ambiguous word meanings, incorrect references and grammatical unclarity. The distinction matters because objective or behaviourally coded speech features are not equivalent to clinical diagnosis.

ORIGINAL NOTES

• Methodologies

• 251 participants.

• Research assistants engaged the subject in recorded semistructured conversations about daily activities, hobbies, and interests.

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[Schwartz (2019)] Give the main diagnosis and symptom comparison results from Schwartz et al.

SUMMARY

Approximately 83% of African American participants received schizophrenia diagnoses compared with 63% of White participants; affective-disorder diagnoses were about 14% versus 33%. Diagnosis variation was statistically significant. The groups did not show statistically significant differences in clinician-rated BPRS conceptual disorganisation or negative symptoms, despite the diagnostic disparity. The data therefore call for scrutiny of how diagnoses are made.

ORIGINAL NOTES

• Results

• Discussion

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[Schwartz (2019)] Explain CDI, intonation and race interactions in Schwartz’s findings.

SUMMARY

The notes report a significant racial-group difference in CDI total score, t(237) = 2.94, p = .004. Associations between communication disorganisation and schizophrenia diagnosis differed by race. Race itself was reported as a strong predictor in models, with African American participants around 3.7 times as likely to receive schizophrenia diagnosis in one analysis, and 2.9 times in an intonation-related analysis. Language-style variation might influence how clinicians interpret pathology, although further research is needed.

ORIGINAL NOTES

• First, we replicated previous literature suggesting diagnostic differences between racial groups. We failed to find group differences in current symptomatology.

• In summary, it is unclear whether the observed CDI differences in the present study reflect normative variations observed in the sociolinguistic literature more generally.

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[Schwartz (2019)] Evaluate Schwartz’s evidence for cultural insensitivity without overclaiming.

SUMMARY

The racial diagnostic disparity despite no significant group differences in some clinician-rated symptoms is compatible with cultural insensitivity. The authors suggested clinicians may misunderstand normal linguistic variation or apply inappropriate reference standards. However, CDI differences were also observed, and a clinical diagnosis reflects longitudinal history, collateral reports and broader information rather than a single brief symptom measure. The study does not prove stereotyping caused the diagnostic differences, and the authors called for further work.

ORIGINAL NOTES

• Discussion

• First, we replicated previous literature suggesting diagnostic differences between racial groups. We failed to find group differences in current symptomatology.

• In summary, it is unclear whether the observed CDI differences in the present study reflect normative variations observed in the sociolinguistic literature more generally.

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[Schwartz (2019)] Use Schwartz et al. to justify culturally sensitive diagnostic assessment and staff training.

SUMMARY

Schwartz found disproportionately high schizophrenia-spectrum diagnosis among African American participants and raised concerns about cultural interpretation of speech. Assessment training should address variations in language, eye contact, emotional expression and nonverbal communication; clinicians should examine cultural norms and avoid inappropriate reference populations. Multiple information sources and culturally responsive assessment could reduce misinterpretation. These are reasoned recommendations, not directly tested treatment effects in Schwartz’s study.

ORIGINAL NOTES

• First, we replicated previous literature suggesting diagnostic differences between racial groups. We failed to find group differences in current symptomatology.

• In summary, it is unclear whether the observed CDI differences in the present study reflect normative variations observed in the sociolinguistic literature more generally.

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[Solutions] Develop a full argument for expanding non-WEIRD sampling and conducting cross-cultural replication.

SUMMARY

Problem: samples concentrated in WEIRD settings can be treated as universal despite cultural variation. Evidence: Berry (1967) found substantially greater conformity among Temne than Inuit participants in a comparable task; the notes cite the predominance of WEIRD participants in research. Solution: recruit across societies, socioeconomic settings and cultural backgrounds, and independently replicate findings before universalising them. Mechanism: tests which patterns are robust and which depend on cultural/economic conditions. Limitation: recruitment, translation and test equivalence can be difficult; note restrictions on generalisability when replication is impossible.

ORIGINAL NOTES

• W.E.I.R.D

• Otherwise, caution against (2nd solution) making universal generalisations beyond the sample

• Shows something that was thought as fundamental as conformity is actually culturally influenced

• Hypothesis:

• Methodologies

• Results and Discussion

• Both traditional and transitional Temne samples show a highly significant tendency to accept the suggestion of the group norm, while the Inuit almost disregard it.

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[Solutions] Develop a full argument for diversifying research teams and involving culturally knowledgeable collaborators.

SUMMARY

Problem: researchers’ own norms can influence what they investigate, their instructions, measurements and interpretations. Evidence: Berry shows cultural variation in conformity; Griner and Smith describe culturally informed consultation and treatment adaptations; the Meihana material shows why local concepts matter. Solution: involve diverse researchers and culturally knowledgeable collaborators in design, recruitment, translation, analysis and interpretation; use local leaders to flag barriers and blind spots. Mechanism: improves relevance, acceptability and cultural validity. Limitation: representational diversity alone does not guarantee cultural competence or agreement within a cultural group.

ORIGINAL NOTES

• Diversify Research Staff: Similarly, reference differences in culture from Berry (1967) and also use that to argue how research constructions could be biased by experimenters assumptions. Also reference the Griner & Smith (2006) to argue that they could identify blind spots regarding language and non-verbal cues and social norms that may influence cross-cultural testing

• Following on from this and using the same body of evidence, potentially have community-led recruitment with community leaders to also identify blind-spots

• Use the Mahi a Atua (Rangihuna et al., 2019) study to argue how Maori values and concepts could be integrated into clinical practice or research designs. This promotes an Emic approach using indigenous psychologies to build theories. Could also extend this to validating assessment tools across cultures and as well have external input / more diverse research group

• Again, supported by Berry (1967) Independence and Conformity in Subsistence-Level Societies to argue for researchers actively reflecting on their own cultural values and privileges before and during a study

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[Solutions] Develop a full argument for community-led or culturally collaborative recruitment.

SUMMARY

Problem: externally designed recruitment may exclude groups or overlook norms affecting participation and trust. Solution: consult culturally knowledgeable local leaders and participants when designing materials, approaches and consent processes, and use feedback to adapt recruitment. Griner and Smith documented culturally oriented outreach and collaboration in intervention studies; the Meihana material emphasises responsiveness to clients and whānau. Potential benefit: better inclusion, trust and contextual fit. Limitations: leaders may not represent everyone, recruitment can introduce selection effects, and procedures must protect individual consent and autonomy.

ORIGINAL NOTES

• Following on from this and using the same body of evidence, potentially have community-led recruitment with community leaders to also identify blind-spots

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[Solutions] Develop a full argument for culturally adapted interventions and preferred-language provision.

SUMMARY

Problem: Western individualistic therapy and unfamiliar language or values may reduce therapeutic fit and engagement. Evidence: Griner and Smith (2006) synthesised 76 studies and found mean d = .45 for culturally adapted interventions; language-matched studies had around twice the effects of unmatched studies. Solution: integrate relevant cultural values, provide preferred-language clinicians/interpreters when appropriate, consider family and spiritual supports and tailor delivery to clients’ circumstances. Mechanism: improved understanding, trust, engagement and acceptability. Limitations: individual variation within ethnic groups; matching is not sufficient; meta-analytic associations do not isolate causation.

ORIGINAL NOTES

• Recommendations as outlined in literature (omg gives so many solutions that I could list and then say these were the overall result of culturally adapted interventions)

• Results

• The studies included in this meta-analysis involved several different types of outcome measures (i.e., mental health symptoms, client retention, client satisfaction)

• Discussion

• This may be partly due to intracultural or intraethnic heterogeneity within participating populations. Simply being part of the same ethnic group may not indicate a common understanding

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[Solutions] Develop a full argument for using emic perspectives and culturally appropriate assessment models.

SUMMARY

Problem: imposed etics can treat culturally normal experience as abnormal or overlook local distress expressions. Evidence: Schwartz et al. report racial diagnostic disparities and discuss linguistic style; the Meihana material describes culturally appropriate whānau, wairua, hinengaro, tinana, taiao and iwi-katoa domains. Solution: consult local cultural understandings, adapt and validate assessment tools, contextualise diagnoses, and involve whānau as desired. Mechanism: improved construct and diagnostic validity. Limits: specialised training, resources and challenges comparing culturally specific results across groups.

ORIGINAL NOTES

• Etic Approach and Imposed Etics

• However, when applied appropriately, it can be useful for creating cross-cultural comparisons

• Emic Approach

• Examines behavior from the inside using the specific meanings, language, and categories of the local culture.

• However this, makes cross-cultural comparison difficult and can limit generalisability of psychological processes and therapeutic treatments to specific cultural contexts

• Results

• Rationale: To ensure cultural accountability of measures used to provide evidence that supports or challenges hypotheses around the presenting behaviours.

• Dimension: Wairua

• Definition: Level of attachment to identity, values, faith, tradition, ancestors, etc.

• First, we replicated previous literature suggesting diagnostic differences between racial groups. We failed to find group differences in current symptomatology.

• In summary, it is unclear whether the observed CDI differences in the present study reflect normative variations observed in the sociolinguistic literature more generally.

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[Solutions] Develop a full argument for clinician cultural competence and reflexivity.

SUMMARY

Problem: clinicians may apply their own norms and professional assumptions to a client’s behaviour. Solution: training in cultural safety, self-reflection on cultural identity/bias and collaborative interpretation of distress; regularly seek client preferences and feedback. Schwartz raises potential diagnostic misinterpretation; the Meihana material documents practitioners struggling to apply holistic models; Griner and Smith support culturally responsive care. Mechanism: more accurate interpretation and a stronger therapeutic relationship. Limit: training alone may be insufficient without institutional policy, supervision and suitably resourced services.

ORIGINAL NOTES

• Discussions of culture in psychiatry tend to focus on the minority patient who is presumed to be culturally distinctive in some way. However, psychiatry itself is a cultural institution. Medical anthropology has shown how many aspects of psychiatric theory and practice are based on specific cultural concepts of the person. The perspective of clinicians is also a function of their own ethnocultural background, their professional training, and the context in which they work. Hence, it is best to frame issues of cultural difference not simply in terms of the characteristics of patients or communities, but in terms of differences in the perspectives of patient and clinician in what is always, to some degree, an intercultural encounter.

• General clinician cultural competency

• the clinician’s task involves acquiring sufficient understanding of the patients’ point of view and preferences to negotiate a diagnostic interpretation and treatment strategy that will be acceptable and effective. There is considerable evidence that conventional psychiatric approaches are not effective for many patients because of the failure to undertake or accomplish this clinical negotiation. One indication of this failure is the generally low rate of patient “compliance” with treatment where rates of noncompliance are much higher in intercultural settings

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[Solutions] Evaluate the limitations of ethnic matching as a solution.

SUMMARY

Matching patients and clinicians or diversifying teams can improve access to cultural knowledge, yet identity overlap does not guarantee aligned beliefs, language, experience or competence. The notes explain that training may distance practitioners from previously familiar practices, and matching can be infeasible for small migrant populations. Griner and Smith reported unexpected findings for inconsistent ethnicity matching and stressed intra-group heterogeneity. A more defensible response combines diverse staff with general cultural competence, client-centred preferences, supervision and consultation.

ORIGINAL NOTES

• This may be partly due to intracultural or intraethnic heterogeneity within participating populations. Simply being part of the same ethnic group may not indicate a common understanding

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[Solutions] Evaluate the dangers of superficial cultural checklists and generic multicultural solutions.

SUMMARY

The Meihana material reports that treating Te Whare Tapa Whā as generic “best practice” can erase its Māori origin and encourage one checklist for all minority clients. Griner and Smith reported greater effects for adaptations directed at single racial/ethnic groups (d = .49) than mixed-race groups (d = .12), though this comparison is not definitive causal proof. Effective solutions should be grounded in particular cultural meanings and individual preferences without stereotyping group members or assuming every person identifies with the same traditions.

ORIGINAL NOTES

• This may be partly due to intracultural or intraethnic heterogeneity within participating populations. Simply being part of the same ethnic group may not indicate a common understanding

• Results

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[Synthesis] Synthesis: Explain cultural bias in psychology, demonstrate it using two studies, and recommend two evidence-based solutions.

SUMMARY

Begin with ethnocentrism or imposed etics and explain how Western assumptions affect research or diagnosis. Evidence option 1: Berry (1967), where Temne and Inuit participants differed significantly in conformity, demonstrating limits to universal claims. Evidence option 2: Schwartz (2019), with 83% versus 63% schizophrenia diagnosis and no significant variation in certain clinician-rated symptoms, consistent with possible cultural insensitivity. Solutions: diversify samples and replicate across populations; validate culturally appropriate assessment, train clinicians, and include emic/local perspectives. Support solutions with Griner and Smith or Meihana materials and evaluate practicality, causal limits and within-group variation.

ORIGINAL NOTES

• Cultural relativism takes the opposite stance. It values a culture’s practices from that culture’s own point of view, rather than judging them by outside assumptions.

• Acknowledging that a client’s worldview is valid fosters psychological safety, reducing premature drop-out rates and stigma-driven reluctance

• Etic Approach and Imposed Etics

• However, when applied appropriately, it can be useful for creating cross-cultural comparisons

• Emic Approach

• Examines behavior from the inside using the specific meanings, language, and categories of the local culture.

• However this, makes cross-cultural comparison difficult and can limit generalisability of psychological processes and therapeutic treatments to specific cultural contexts

• W.E.I.R.D

• Otherwise, caution against (2nd solution) making universal generalisations beyond the sample

• Following on from this and using the same body of evidence, potentially have community-led recruitment with community leaders to also identify blind-spots

• General clinician cultural competency

• Results and Discussion

• Both traditional and transitional Temne samples show a highly significant tendency to accept the suggestion of the group norm, while the Inuit almost disregard it.

• Results

• The studies included in this meta-analysis involved several different types of outcome measures (i.e., mental health symptoms, client retention, client satisfaction)

• Discussion

• This may be partly due to intracultural or intraethnic heterogeneity within participating populations. Simply being part of the same ethnic group may not indicate a common understanding

• Results

• Discussion

• First, we replicated previous literature suggesting diagnostic differences between racial groups. We failed to find group differences in current symptomatology.

• In summary, it is unclear whether the observed CDI differences in the present study reflect normative variations observed in the sociolinguistic literature more generally.

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[Synthesis] Synthesis: Evaluate which cultural-bias solutions are strongest for research versus clinical practice.

SUMMARY

In research: broaden WEIRD samples, replicate findings, build culturally diverse/collaborative teams and limit unsupported generalisations. Berry supplies evidence of culturally variable conformity. In practice: culturally responsive assessment, preferred-language support, family/spiritual context where wanted and clinician cultural competence. Schwartz indicates possible diagnostic problems; Griner and Smith synthesise evidence of improved outcomes for adapted treatment, while the Meihana material offers a culturally grounded framework. Evaluate intervention specificity, staff training, limited resources and the fact that not every statistical association proves the suggested mechanism.

ORIGINAL NOTES

• Otherwise, caution against (2nd solution) making universal generalisations beyond the sample

• Following on from this and using the same body of evidence, potentially have community-led recruitment with community leaders to also identify blind-spots

• General clinician cultural competency

• Both traditional and transitional Temne samples show a highly significant tendency to accept the suggestion of the group norm, while the Inuit almost disregard it.

• Results

• The studies included in this meta-analysis involved several different types of outcome measures (i.e., mental health symptoms, client retention, client satisfaction)

• Discussion

• This may be partly due to intracultural or intraethnic heterogeneity within participating populations. Simply being part of the same ethnic group may not indicate a common understanding

• Results

• Discussion

• First, we replicated previous literature suggesting diagnostic differences between racial groups. We failed to find group differences in current symptomatology.

• In summary, it is unclear whether the observed CDI differences in the present study reflect normative variations observed in the sociolinguistic literature more generally.

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[Synthesis] Synthesis: Compare what Berry, Griner and Smith, the Meihana material and Schwartz contribute to a cultural-bias essay.

SUMMARY

Berry (1967) demonstrates variation in a psychological process across cultural/economic environments and supports caution about universalisation. Griner and Smith (2006) provide quantitative synthesis of culturally adapted treatment outcomes and possible benefits of language matching, alongside caveats. Meihana material shows how Māori concepts can inform assessment and illustrates risks of superficial implementation. Schwartz et al. (2019) show racial variation in diagnostic decisions and possible linguistic misinterpretation, without proving bias as the sole cause. Select studies according to whether the paragraph is about showing bias, justifying an intervention or evaluating limitations.

ORIGINAL NOTES

• Results and Discussion

• Both traditional and transitional Temne samples show a highly significant tendency to accept the suggestion of the group norm, while the Inuit almost disregard it.

• Results

• The studies included in this meta-analysis involved several different types of outcome measures (i.e., mental health symptoms, client retention, client satisfaction)

• Discussion

• This may be partly due to intracultural or intraethnic heterogeneity within participating populations. Simply being part of the same ethnic group may not indicate a common understanding

• Limitations for Any Solutions

• Methods

• It became clear from these interviews that while these clinicians were familiar with the core principles they often struggled to put the model into practice within their clinical settings.

• The developed model was then piloted by two psychologists, one nurse, and one GP over 5 years. Discussions between clinicians provided feedback for the Meihana Model in clinical settings

• Results

• Discussion

• First, we replicated previous literature suggesting diagnostic differences between racial groups. We failed to find group differences in current symptomatology.

• In summary, it is unclear whether the observed CDI differences in the present study reflect normative variations observed in the sociolinguistic literature more generally.