Abnormal Psychology. William J. Ray

      There is a movement in the training of mental health professionals to emphasize cultural competence.

      © iStockphoto.com/Pamela Moore

      Beginning in the 1950s and 1960s, there was a movement among researchers and clinicians to evaluate the effectiveness of both medical and psychological assessment and treatment in a scientific manner. In medicine, this came to be known as evidence-based medicine. In psychology, the terms empirically based treatments and empirically based principles refer to assessment and treatments and their aspects for which there is scientific evidence that the procedure is effective.

      Recently, a movement in the training of mental health professionals has begun to emphasize cultural competence (Delvecchio Good & Hannah, 2015). In this approach, the focus of interventions begins with the person who is being served. That is, a clinician should consider and understand the worldview of the individual she is treating. This includes the client’s willingness to describe internal thoughts and feelings, how he understands how a particular disorder affects him, what he expects from his treatment, as well as his relationships with significant others. For example, in one study, Latinos with depression were less likely to take antidepressants since they had cultural concerns about addiction or dependence (Vargas et al., 2015).

      The existence of these two movements has led to a debate concerning the degree to which a particular psychological disorder should be considered from a more universal standpoint (represented by empirically based principles) as opposed to a manifestation of cultural processes (represented by cultural competence). This debate is of particular concern in countries such as the United States where there has been a lot of immigration from different cultures leading to an increasingly diverse population. At the same time, increases in the numbers of women as well as individuals from different cultures becoming mental health professionals have led to significant changes in the diversity of those offering health and mental health services.

      For some researchers, there is a dynamic tension between cultural considerations with an emphasis on the individual client and his or her way of expressing and experiencing mental illness, and empirically based principles that emphasize treating all clients in a consistent manner (Delvecchio Good & Hannah, 2015). That is, there is a tension between flexibility and consistency. Other researchers suggest this dynamic tension can be overcome by beginning with particular cultural groups and developing an intervention based on the cultural factors found in that particular group (Weisner & Hay, 2015).

      One alternative is to classify treatments in terms of culture (Evans, 2009). Transcultural concepts and treatments would be appropriate to individuals in all cultures. Multicultural concepts and treatments would be appropriate for individuals from groups that have similar worldviews, practices, and traditions. Culturally adapted and culture-specific concepts and treatments would be designed for individuals from a specific group. At this point, however, there has been limited research that fully integrates cultural factors with empirically supported approaches to treatment (Helms, 2015; V. H. Jackson, 2015).

      Thought Question: What are some particular benefits that each of these two approaches—empirically based principles and cultural competence—bring to psychological treatment? If you were a mental health professional, how would you bring the benefits of the two approaches to your clients?

      Reliability and Validity in Relation to Psychopathology

      Concerns about the accuracy of assessment and classification of psychopathology require us to consider two very different questions. The first has to do with the person who is being interviewed. We need to know if the person is giving us information that is accurate or not. Sometimes, individuals will “fake bad” if there is some advantage such as receiving a larger disability payout. Other times, individuals will “fake good” and deny there are any problems.

      The second question is which assessment instruments to use. An assessment instrument can be an interview, an inventory, a mood scale, and so forth. In considering instruments, we think about measurement. Measurement considerations help to define the variety of instruments that we use and the theoretical variables that these reflect.

      Traditionally, the two key measurement issues are reliability and validity. That is, does an instrument measure the construct consistently (reliability) and accurately (validity)? The measurement of temperature, for example, is based on the kinetic theory of heat, which helped define the type of devices used. With psychopathology, however, we lack exact formal definitions that tell us exactly how to make measurements. In fact, we are both trying to learn about disorders and creating techniques for making diagnoses. This makes reliability and validity considerations both more difficult and more important.

      reliability: consistency of the measurement by an assessment instrument

      Reliability

      Reliability asks the question of whether the instrument is consistent. We would expect, for example, that the odometer in our car would reflect that we drove a mile each time we drove 5,280 feet. We would also expect our bathroom scale to show the same reading if our weight had not changed. Researchers interested in questions of measurement discuss a number of types of reliability: