Journal of Consulting and Clinical Psychology 1991, Vol. 59, No. 6,799-812 Copyright 1991 by the American Psychological Association. Inc. 0022-006X/91/S3.00 Cultural Diversity and Treatment of Children Roland G. Tharp University of California, Santa Cruz The increasing cultural diversity of child clients has produced a cascade of new issues and concerns for psychological practice, theory, and research. Available evidence and pertinent theory are re- viewed on such topics as the predictive utility and treatment consequences of ethnic membership, whether treatments should be generic or specific to cultural groups, the degree of privilege that should be accorded to same-culture therapists, and the relative desirability of different modalities of treatment for children of different cultural groups. The concept of cultural compatibility of treatment is explored and evaluated. A broad agenda of hypotheses for research and development is suggested, and some guidelines for clinical practice and policy are proposed. It is concluded that insofar as possible, treatment for all children should be contextualized in their family's and commu- nity's structure of meanings, relationships, and language. The culturally diverse society that our nation has become provides a challenge to our politics, our schools, our science, and our profession. As reiterated by concerned commissions, agencies, professional organizations, and review articles in- cluding the current Guidelines for Providers of Psychological Services to Ethnic andCulturatty Diverse Populations (American Psychological Association, 1990), we are instructed that "Psy- chologists should recognize ethnicity and culture as significant parameters in understanding psychological processes" (p. 4) before delivering services. What will be necessary to satisfy this new imperative? Self-examination? New specialized training? Anthropological indoctrination, religious and spiritual relativ- ism, multilingualism, "politically correct" thought? And most to the point, what are the required practical clinical actions? In discussing these questions, Pedersen and Marsella (1982) con- clude that to know all and do all that a psychologist should is a goal that accelerates beyond us. The task is to bring some order out of this cascade of new issues and concerns, in the light of available research evidence and pertinent theory. I will suggest here that some broad out- lines for strategy are emerging, with enough clarity at least to pose an agenda of hypotheses for research and development, and possibly even to provide an initial set of guidelines for clinical practice and policy. These strategies can be stated clearly enough to allow them to be tested by both formal evalua- tion and clinical experience. Not to overpromise, it should be said that research on cul- tural issues in clinical treatment is scant, particularly research addressing such issues with children. We must rely on evidence from other age grou ...

1. Journal of Consulting and Clinical Psychology
1991, Vol. 59, No. 6,799-812
Copyright 1991 by the American Psychological Association.
Inc.
0022-006X/91/S3.00
Cultural Diversity and Treatment of Children
Roland G. Tharp
University of California, Santa Cruz
The increasing cultural diversity of child clients has produced a
cascade of new issues and concerns
for psychological practice, theory, and research. Available
evidence and pertinent theory are re-
viewed on such topics as the predictive utility and treatment
consequences of ethnic membership,
whether treatments should be generic or specific to cultural
groups, the degree of privilege that
should be accorded to same-culture therapists, and the relative
desirability of different modalities
of treatment for children of different cultural groups. The
concept of cultural compatibility of
treatment is explored and evaluated. A broad agenda of
hypotheses for research and development is

2. suggested, and some guidelines for clinical practice and policy
are proposed. It is concluded that
insofar as possible, treatment for all children should be
contextualized in their family's and commu-
nity's structure of meanings, relationships, and language.
The culturally diverse society that our nation has become
provides a challenge to our politics, our schools, our science,
and our profession. As reiterated by concerned commissions,
agencies, professional organizations, and review articles in-
cluding the current Guidelines for Providers of Psychological
Services to Ethnic andCulturatty Diverse Populations (American
Psychological Association, 1990), we are instructed that "Psy-
chologists should recognize ethnicity and culture as significant
parameters in understanding psychological processes" (p. 4)
before delivering services. What will be necessary to satisfy
this
new imperative? Self-examination? New specialized training?
Anthropological indoctrination, religious and spiritual relativ-
ism, multilingualism, "politically correct" thought? And most
to the point, what are the required practical clinical actions? In
discussing these questions, Pedersen and Marsella (1982) con-
clude that to know all and do all that a psychologist should is a
goal that accelerates beyond us.
The task is to bring some order out of this cascade of new
issues and concerns, in the light of available research evidence
and pertinent theory. I will suggest here that some broad out-
lines for strategy are emerging, with enough clarity at least to
pose an agenda of hypotheses for research and development,
and possibly even to provide an initial set of guidelines for
clinical practice and policy. These strategies can be stated
clearly enough to allow them to be tested by both formal
evalua-
tion and clinical experience.

3. Not to overpromise, it should be said that research on cul-
tural issues in clinical treatment is scant, particularly research
addressing such issues with children. We must rely on evidence
from other age groups and look to related literatures (family and
community) where child treatment is discussed. Cultural issues
in the education of children is a field somewhat more mature,
and if considered cautiously, evidence from that field can serve
by analogy. Other disciplines, notably anthropology and lin-
guistics, have a longer history with the study of ethnic and
Correspondence concerning this article should be addressed to
Ro-
land G. Tharp, Merrill College, University of California, Santa
Cruz,
California 95064.
cultural diversity, and psychology can anticipate from their ex-
perience. In attempting to discern the figure in this ground, we
can fit some of these diverse tesserae into the beginning of a
mosaic. Still, there are more spaces than tiles.
Basic Questions
Concerns arising from both theory and practice converge on
four basic questions about the implications of cultural member-
ship for the treatment of children. First, is there a useful level
of
developmental analysis, which I will call here ethnogenetic, that
accounts for important current features of a childls psychology
in terms of the historical forces operating on his or her ances-
tors in a time frame of hundreds to thousands of years? That is,
does ethnogenesis, which lies in the dimension of time between
phylogenesis and ontogenesis, provide critical elements for un-

4. derstanding and treating the child's present condition?
Second, are there present in cultures psychosocial features so
widely shared that membership is a useful guide for prescrip-
tion of clinical services? Or, conversely, does membership as a
guide result in stereotypical overgeneralization, and are more
conventional individual and family descriptors to be preferred?
Third, are there forms of treatment—either potential or ac-
tual—that are specifically or uniquely suited for the treatment
of children of different cultures? It is important to differentiate
specific from unique. Although one or another form of therapy
may be specifically suited for members of one culture, that does
not mean that the modality is exclusively suited to them; family
therapy, for example, might prove to be the treatment of choice
of members of several cultures, whereas the sweat lodge might
be uniquely suited to those of only one.
Fourth, are culture members privileged in the capacity to
treat or to investigate the treatment of children of their own
culture? Although the literature has not necessarily developed
in response to them, these questions may be borne in mind as
the available knowledge is reviewed.
Cultural Differences in Diagnosis and Treatment
Cultural Differences in Pathology
Some childhood disorders are of particular frequency in cer-
tain cultural groups, because of either characteristic social
799
800 ROLAND G. THARP

5. problems or psychosocial structures. Weisz, Suwanlert, Chaiya-
sit, and Walter (1987) consider psychosocial differences by con-
trasting Thailand, a Buddhist nation, which discourages chil-
dren's aggression and encourages inhibition, peacefulness,
politeness, and deference, with the United States, where inde-
pendence, competitiveness, and differentiation from the family
as the goal of socialization is widespread. In Thailand, children
and adolescents are referred for clinic treatment more often for
"overcontrolled syndrome" (fearfillness, sleep problems, soma-
ticizing), whereas in the United States referred children and
adolescents are reported more often with "undercontrolled
syndrome" (disobedience, fighting, arguing). The same general
pattern is discernible in an epidemiological study, although the
culturally consistent trends are more marked in parents' deci-
sions to refer for treatment than in their general ratings of their
children (Weisz, Suwanlert, Chaiyasit, Weiss, et at, 1987). An-
other "overcontrolled" society (Jamaican) has produced similar
results (Lambert, Weisz, & Knight, 1989).

6. Many describe minority status itself as a stressor, because it is
often associated with hostility and prejudice. According to
Moritsugu and Sue (1983) minority status also often is asso-
ciated with a lack of effective support during crises and the
danger of developing ineffective cognitive coping styles. The
status of all minorities, however, is not the same, and neither
are
their characteristic stressors nor responses to them. In the field
of minority education, the nature of stress and the responses to
it are often differentiated for the children of voluntary immi-
grant groups versus those of "involuntary" minority children.
Children of the latter (such as African Americans and Native
Americans) learn that education does not lead to economic
improvement, and they become withdrawn and hostile in
school. Children of recent minority groups, however, may feel
the stress of difference, but see that their people prosper
through education, and they may respond in school by striving.
Gibson and Ogbu (1991), with whose names this analysis is
associated, are now attempting to further differentiate among

7. minority groups as to the specific defenses and coping mecha-
nisms used.
As an example of disorders in response to culturally charac-
teristic stressors, Indochinese refugee children treated in Cali-
fornia were recovering from such severe stress that application
of categories from the Diagnostic and Statistical Manual of
Mental Disorders (3rd ed., DSM-III, 1980, American Psychiat-
ric Association) was confounded (Krener & Sabin, 1985). The
pattern is found with Central American refugee children as well
(Arredondo, Orjuela, & Moore, 1989). "For every one of our
patients, Axis I DSM-III diagnoses could be reached on the
basis of the patient's fulfilling the criteria, but the diagnosis
was
felt to be incompletely descriptive or fundamentally wrong"
(Krener & Sabin, 1985, p. 457). The issue does not derive only
from specific stress; their Indochinese child patients revealed
cross-cultural child-rearing differences and their potential mis-
construing as psychopathology. For example, the American
concept of mourning includes a sequencing of stages and a time

8. limitation. Indochinese, who believe that the dead live after
bodily death, may be seen as manifesting pathological or in-
complete grief. "Particular DSM-III diagnostic categories. . .
break down when we attempt to apply them cross-culturally,
and . . . may have only qualified validity within our own cul-
ture" (Krener & Sabin, 1985, p. 457). These authors decry the
practice of applying the diagnostic scheme of one culture to
child patients from another.
Among indigenous minorities, there are also characteristic
child problems. Because of high rates of death and displace-
ment, Crow Indian children objectively experience repeated
and traumatic loss; they suffer a chronic condition of mourning
and depression (Long, 1983). The common plight of the acting-
out, depressed, poor, alienated Black male adolescent is an-
other example of a disorder so frequent in that group as to
require a psychocultural category. Paster (1985) provides a dis-
cussion of this syndrome, emphasizing the way that political,
historical, societal, economic, interpersonal, and intrapsychic

9. factors may be seen as intertwined and reciprocally reinforcing;
the article is an example of how ethnogenetic, ontogenetic, and
microgenetk levels of analysis integrate.
When such integrated-genetic analyses are performed, it is
difficult to discount cultural factors. The case can be made that
not only in minorities are cultural, ethnogenetic features pres-
ent in psychopathology.
The overwhelming evidence of cultural psychiatric literature. . .
is that cultural factors are a substantial part of every disorder
and
not a descriptive, picturesque component.. . . What is lacking in
the [DSM-III] system, from a Latin-American perspective, is the
explicit recognition of psychocultural categories or cultural
crite-
ria—or both—to aid in the identification of crucial categories
and in the description of clusters of symptoms. (Alarcon, 1983,
p.
104)
The even stronger case is made by Marsella and Higgenbotham
(1984), who argue that reserving the term culture-specific for
exotic disorders merely delays the awareness that all disorders
are culture-specific, and so is all treatment.
Cultural Differences in Treatment

10. Do clients of all cultures receive equal mental health services?
Meta-analyses of research conclude that the issue is not clear
(Atkinson, 1985; Sue & Zane, 1987) because of the usual re-
search problems of nonuniformity of treatment goals, inaccessi-
bility of records, inappropriate analog designs, and absence of
any process research. However, to illustrate the issue, we may
consider a set of data that appear to make the optimistic case,
that clients are offered about the same services according to
diagnosis and prognosis, without regard for ethnicity. Sue, Al-
len, and Conaway (1978) studied 13,450 clients and found no
evidence that Hispanic or Native-American clients in commu-
nity mental health facilities were offered inferior or discrimina-
tory services in either diagnosis, assigned personnel, or type of
treatment. However, Hispanic and Native American clients fre-
quently did not return after the initial treatment session. In
these facilities, the dropout rates were Hispanic 42%, Indian
55%, Black 52%, Asian-American 52%, and Anglo clients only
30%. Why are these rates so high for minority culture clients?
The authors indict not only the fit of the assigned type of ser-

11. vice, but the quality of the professional interaction. Thus the
same service is not necessarily responsive service, and in its
effects, identical is not necessarily equal.
Techniques that are of demonstrated utility in one culture
may not operate in the same way for others. In a study con-
SPECIAL SECTION: CULTURAL DIVERSITY 801
ducted by Lieh-Mak, Lee, & Luk (1984), Hong Kong Chinese
parents were trained to be mediators of behavior therapy for
their own children, but the therapists reported severe culturally
based reluctance, arising from patterns of traditional family
structure and interaction. These parents found it difficult to
play with their children or respond contingently with praise or
ignoring, because this violated their accustomed mode of child
rearing, their beliefs about childhood problems, and their atti-
tudes about the proper role of doctors. Thus Lieh-Mak, Lee, &
Luk warn against the ethnocentric bias involved in importing
treatment modalities from one culture to another.
Cultural Differences in Knowledge
The core of the problem, according to King, Moody, Thomp-
son, & Bennett (1983), is that mental health intellectual and
institutional constructions
reflect the orientations of educators, researchers, and therapists
who too often make judgments about and define programs for
Black persons and communities with insufficient data on the na-

12. ture of these persons and communities, their beliefs, values or
their abilities and resources. We have almost developed an inca-
pacity to shift from our Anglo-American perceptions, to change
our attitudes and to foster real change. (King et al., 1983, p. 5)
This perception of establishment ignorance and nonrespon-
siveness is not limited to African-American psychologists.
Although non-Indian psychologists are becoming increasingly
in-
volved in mental health service delivery to American Indians,
they are, unfortunately, typically not prepared to work
effectively
with Indian clientele. The non-Indian psychologist may not be
aware of the cultural values, life-styles, family practices,
develop-
mental progressions, and needs of their American Indian clients.
This lack of cultural awareness typically results in conflicts and
frustrations for both the psychologist and his or her Indian
clients;
ultimately, American Indian children and families may not re-
ceive appropriate mental health services. (Everett, Proctor, &
Cartmell, 1983, p. 588)
Not only is the individual client harmed, but child workers who
devalue native culture may actually intensify social disorgani-
zation in Indian communities (Sullivan, 1983).
The single most important explanation for the problems in
service
delivery involves the inability of therapists to provide culturally
responsive forms of treatment.. . .Most therapists are not famil-
iar with the cultural backgrounds and life-styles of various
ethnic-
minority groups and have received training primarily developed
for Anglo, or mainstream, Americans. . . [and ] are often unable

13. to devise culturally appropriate forms of treatment, and ethnic-
minority clients frequently find mental health services strange,
foreign, or unhelpful. (Sue & Zane, 1987, p. 37)
Many mental health professionals find clients of some cul-
tures strange and unhelpful, or even harmful, for example in
the area of child abuse/neglect. Gray and Cosgrove (1985) inter-
viewed Mexican, Samoan, Vietnamese, Filipino, Japanese, and
Blackfoot as to their culturally normative child rearing values
and practices. The researchers then examined these practices
for the likelihood of their being misunderstood as "abuse" or
"neglect" by child-protective professionals. That potential for
misunderstanding is very high, particularly around two basic
topics: the degree of responsibility delegated to children and
the degree to which children should submit to adult domi-
nance. The authors suggest that ignorance of these differential
norms will lead to mistreatment of some parents by ethnocen-
tric social workers. It should be noted that the potential for
misunderstanding of one another's parenting conventions
across all ethnic groups is high, and not restricted to Euro-
Americans. However, the institutionalization of Euro-Ameri-
can norms into professional assumptions is a hazard to ad-
vances in psychocultural understanding and to the just percep-
tion of parents' behaviors within other cultures. A source book
on ethnic child socialization is Phinney and Rotheram (1987),
on cultural approaches to parenting is Bernstein (1991), and an
analysis of the use of such information in understanding child
abuse and neglect is Korbin (1980).
Much of the research and professional literature in culture
and mental health attempts to provide enough information to
sensitize psychologists to cultural issues in diagnosis and treat-
ment. Several journals have published special issues on culture
and mental health, and edited books on the topic are the most
typical medium of communication. The typical pattern of

14. these publications is to have several chapters on specific cul-
tures, book-ended by introductory and summary chapters that
attempt more general discussions.' This construction well com-
municates the state of analysis of the issues. The field suffers
from a shortage of empirical studies of program or variable
evaluation, and there are virtually no studies of process in
cross-cultural treatment. Nevertheless, this literature can sensi-
tize the therapist to some issues that may be present for cul-
turally unfamiliar clients.2
Differences Within Cultures
This general approach—to learn as much about cultures as
possible—is frustrated by significant differences among sub-
groups and individuals within cultures. Everett, Proctor, and
Cartmell (1983) point out the vast intertribal, interclan, urban-
traditional, and individual differences among American In-
dian clients. Isomura, Fine, and Lin (1987) discuss the differ-
ences in offering services to Japanese immigrant families of the
first, second, and third generations. Hispanic cultures differen-
tiate among themselves; Cuban-, Mexican-, and Puerto Rican-
Americans celebrate their distinctions as well as their common
causes. Although clients expect respect and understanding of
1 See, e.g, Atkinson, Morton, and Sue (1989); Pedersen,
Sartorius,
and Marsella (1984); Chunn, Dunston, and Ross-Sheriff (1983).
2 Notable journals include a special issue of Psychotherapy
titled
"Psychotherapy with Ethnic Minorities." There is a special issue
of the
American Journal of Social Psychiatry on psychiatric care of
minority

15. groups, ftmily therapy with immigrant families is treated in
Journal of
Strategic and Systemic Therapies, and Journal of Drug Issues
has a
special issue on "Alcohol Problems and Minority Youth." A
useful
compilation of orientations to family structure and function,
with im-
plications for family treatment, is discussed for 20 different
cultural
groups in McColdrick, Pearce, & Giordano (1982), and more
recently
by Ho (1987,1990), who presents useful tabular comparisons of
family-
therapy relevant dimensions by culture. For child treatment, the
most
useful volumes of this sort are Children of Color: Psychological
Interven-
tions With Minority Youth (Gibbs & Huang, 1989) and Ethnic
Issues in
Adolescent Mental Health (Stiffman & Davis, 1990).
802 ROLAND G. THARP

16. their culture and values, all will resent being seen merely as a
representative of a cultural central tendency.
Issues of culture and treatment exist today in a context of
tempestuous intercultural relations in the political and eco-
nomic arena, putting us in hazard of using cultural member-
ship as no more than stereotypical overgeneralization. A part
of the research agenda must therefore be to unpack the cultural
variable (Whiting, 1976) so that differentiating characteristics
within culture can be understood for clinical implications for
individuals. In this way culture can be analyzed for its variable
influence on individuals, in contrast to approaches that assign
an equal value to culture for all members of a group. I am
unaware of such work within mental health disciplines, but an
idea of the strategy is given by work in culture and education
(e.g., Weisner, Gallimore, & Jordan, 1988). Gallimore, Reese,
Balzano, Benson, and Goldenberg (1991), in investigating the
correlates of academic success for children of Mexican immi-
grants, found that the domestic variable with the strongest rela-
tionship to child school success is whether the father uses skills
of literacy/numeracy in his employment (not the level of
father's
education). This kind of finer grained analysis of cultural and
community life would allow us accurately to perceive the dy-
namics of culture in the daily life of the individual child in the
consulting chair.
Faced with these contradictions, confusions, similarities, and
differences, mental health professionals have advocated every
position on the continuum. Some writers bundle all "children
of color" together and believe their cause is common. Other
writers call for culturally derived diversity of treatments, and
others insist on a universality of the form of treatment, al-
though of course purified by a correction of racist attitudes.
Psychological science is now searching for a system of under-
standing, and some theoretical guidance that

17. goes beyond a study of exotic populations from different
cultures
and examines guidelines for excellence for mental health as a
whole. . .the case for emphasizing cultural context in the under-
standing, treatment, and prevention of mental disorders has
been
made extensively and persuasively. . .The problem we face,
how-
ever is going from general knowledge about culture traditions to
specific mental health practices. This is where the
disagreements,
debates, and arguments begin and where the pragmatists fre-
quently lose interest. (Sartorius, Pedersen, & Marsella, 1984,
p. 282)
The Cultural Compatibility Hypothesis
The hypothesis of cultural compatibility suggests that treat-
ment is more effective when compatible with client culture pat-
terns. The hypothesis has a more mature theoretical and re-
search base in child education (Tharp, 1989) than in child men-
tal health, but the issues may be argued in substantially the
same terms. Three forms of this hypothesis exist. The strong
form, or culturally specific version, suggests that the most
effec-
tive interventions for different cultures will be different and
specific (if not unique) to cultures. Proponents are associated
with the effort to derive culturally based modalities or varia-
tions of treatment.
A weaker form is the two-type hypothesis, which suggests
that there are two types of cultures, and therefore two types of
most-effective clinical interventions. The first type is the
major-

18. ity, or Euro-American, culture; the second type includes those
cultures whose students typically experience problems in
schools, who are by-and-large children of color, less industrial-
ized, urbanized, or western acculturated, and who thus share
crucial incompatibilities with standard mental health prac-
tices. In this position, effective treatment strategies for children
of color would not be critically different from one another. This
position is more salient in social work (e.g., Lum, 1986) than in
psychology.
The null form of the cultural compatibility hypothesis is the
universalistic argument that effective treatments will follow the
same course for all cultures. This is the default hypothesis of
clinical psychology, in that the unreflective proceed as though
there are no significant differences. However, many universal-
ists agree that there are some variant subroutines that make
minority children and their families more comfortable and are
willing to engage in the search for these accommodations.
The challenge faced by all is to balance universality and plu-
ralism, preserving an authentic responsiveness to individual
differences while avoiding an impractically large number of
kinds of treatments (Huang & Gibbs, 1989). The obstacles are
several, but they include pervasive psychological theory that
lacks concepts crucial to the solution, and in which culture
itself
plays almost no role as a variable.
Proponents of all three positions appear to be moderately
satisfied with the existing monolith of treatment, as derived
from, practiced by, and practiced for Europeans and Euro-
Americans. Whether their hypotheses call for erecting many
other treatment structures, as in the culturally specific position;
or creating one other alternate for children of color, as in the
two-type hypothesis; or only for modifying and polishing the
universalist structure, there is no systematic understanding

19. that the serious examination of the issues of culture and treat-
ment may well call for a restructuring of the monolith itself,
even for children of its own.
Approaches to Culturally Compatible Treatment
Each of these hypotheses operates in the same arena and
takes its different positions on certain salient issues. These in-
clude modifying professional role behaviors, assigning same-
ethnicity professionals, and searching for the process details
that will create or modify compatible procedures.
Modified Professional Roles in Cross-Cultural Treatment
Jenkins (1985), in discussing Afro-American clients, sug-
gests that they should be approached in a down-to-earth and
egalitarian manner that reduces status differences. In this way a
positive affective response is made more likely, and early treat-
ment attrition is reduced. By contrast, it is not uncommon that
a more authoritative, formal, and concrete therapist role is rec-
ommended for Japanese clients (e.g, Isomura, Fine, & Lin,
1987). Hong (1988) recommends that a psychologist dealing
with an Asian-American clientele operate in a context of gen-
eral family practice as a primary care provider, similar to the
traditional family doctor who provides treatment for clients
and their families, thus assessing the strong and traditional role
of the family, minimizing client families' inhibition against
SPECIAL SECTION: CULTURAL DIVERSITY 803
seeking mental health services, and taking advantage of the
Asian-American's respect and deference to doctors.
Juarez (198S) recommends a firm, instructing, professional

20. demeanor when working with the Hispanic client, as do most
who write from the Latino perspective. However, consider this
quotation from Montijo (1985):
Any therapeutic model that strives to serve poor Puerto Ricans
or
poor people in general cannot. . .enhance the control and hierar-
chical superiority of the therapist at the cost of the greater sense
of
self-esteem produced by the assumption of greater autonomy,
as-
sertiveness, and responsibility by patients, (p. 439)
This contradiction is consistent with differences that flow
from economic class, as well as differences in opinion as to
whether mental health treatment should be seen first as an
instrumentality that feeds and is fed by an existing social order.
Furthermore, as in all efforts to match treatment to culture,
there are wide individual and subgroup/acculturation differ-
ences in client preferences for therapist roles (Sue & Zane,
1987).
Even if there were agreement on recommendations for profes-
sional role stances toward members of different cultures, prob-
lems remain, including the difficulty for any therapist of mani-
festing flexible role behaviors and maintaining authenticity.
More fundamentally, many forms of treatment have theoretical
requirements for specific role characteristics of the therapist.
How much cultural variation in therapist behavior could be
allowed without wounding the core of client-centered therapy,
or psychoanalysis, or any theory driven treatment?
Ethnicity ofTherapists: The Question of Privileged Status
When there are pervasive social attitudes from one culture
toward another, are they likely to infiltrate the therapeutic rela-

21. tionship? Spurlock (1985) and Sykes (1987) both recommend an
early and frank discussion of the comfort of the client in Black/
White cross-cultural treatment, thus assisting both parties to
understand racially based attitudes. Greene (1985), following
Kupers (1981), articulates four general stances that are expres-
sions of racism, and for which White therapists are enjoined to
self-examination. They are (a) bigotry, "a conscious or uncon-
scious belief in White supremacy and as a consequence, the
feeling that the Black patient's problems are an outgrowth of
the patient's inferiority"; (b) color blindness, which "may repre-
sent the therapist's resistance to confronting the meaning of the
color difference'1, (c) paternalism, which "involves the attribu-
tion of all of the patient's problems to society and the effects of
racism. To do this will fail to help patients to understand any
role they may have in their dilemma"; and (d), "often a result of
the therapist's racial guilt, is the unquestioning compliance
with the rhetoric of Black power . . . [which] can result in a
failure or reluctance to set appropriate limits or interpret act-
ing-out." The Black patient may consciously or unconsciously
put the White therapist to a series of tests to determine the
acceptance as an individual. "It remains, however, the thera-
pist's responsibility to be familiar with the Black patient's cul-
ture to some extent, and with his or her own personal feelings
and motivations for and about working with Black patients"
(Greene, 1985; all quotations in this paragraph are from pp.
392-393). Is there any acceptable stance? Or are same-ethnicity
therapists privileged in knowledge and attitude and thus in
power of effectiveness?
College youths have clear preferences for counselors who are
like themselves—in many dimensions, not only ethnicity Sam-
ples give somewhat different results, depending on geographi-
cal location, but by and large students prefer counselors who
are well educated and of the same ethnicity and gender and who
share their attitudes and values; by and large students report

22. themselves more likely to use counseling services when their
preferences are met (Atkinson, Furlong, & Poston, 1986; Atkin-
son, Poston, Furlong, & Mercado, 1989; Haviland, Horswill,
(JConnell, & Dynneson, 1983; Ponterotto, Alexander, & Hink-
ston. 1988). Preference is not the same as effectiveness. In a
discussion of counseling with Mexican-American youth, De-
Blassie (1976) insists that a therapist need not be Hispanic to be
effective. Rather, common humanity is sufficient, and if solid
counseling skills and correct, generous counselor attitudes are
present, so too will be effectiveness. However, this author goes
on to report many areas of values and beliefs that are arguably
specific to Mexican-American youth, knowledge of which is
critical to empathic understanding (DeBlassie. 1976).
Sue (1988), who has labored long in the field of culture and
treatment, reviews the literature on ethnic matching of thera-
pist and client in psychotherapy and finds contradictory and
inconclusive evidence as to whether matching is superior. He
distinguishes between ethnic membership (which emphasizes
national or geographic origin of ancestors) and cultural mem-
bership (which emphasizes current identifications with the
group or groups, and their commonalities of values, attitudes,
motives, etc.). Although concluding that ethnic matching is
irrel-
evant, whereas cultural matching is likely to be an authentic
distal variable affecting outcome, Sue urges researchers to con-
sider more proximal variables, such as how cultural knowledge
is translated into particular therapeutic behaviors and deci-
sions. This position emphasizes the therapist's capacity for
correct understanding and for comfortable communication.
The issue is not whether patients are treated more effectively by
same-race, same-class, or same-sex therapists, but whether the
therapists' interpretation of the clients' cultural experience
creates the ambience that is necessary to establish rapport and
an

23. empathic bond which facilitates the therapeutic process.
(Juarez,
1985, p. 441)
This resolution is similar to that espoused for cultural re-
search by the Cuban-American anthropologist Dominguez
(1985; 1986), who has worked both as "member" and "outsider"
in cultural research. Her position is that "native" members' ac-
counts of their own situation may well be privileged, because of
their intimate, subjective, and empathic knowledge. This does
not excuse native anthropologists' accounts from the disci-
plines of their scholarship and profession and does not invali-
date the outsider anthropologist's account, over which in terms
of objectivity the native account is not ipso facto privileged. By
analogy, it appears that psychological treatment, relying so
heavily on both subjective and objective accuracy of perception,
must attempt to maximize that accuracy in a variety of ways.
Ethnic matching may contribute, but as a matter of practicality
it is not an available strategy, and were it to be adopted, it
would
804 ROLAND G. THARP
exclude minority-culture therapists from treating most clients.
Are there other ways?
Culturally Specific Treatment Modalities
Many writers (e.g^ da Silva, 1984) urge therapists to become
aware of ethnogenetically determined patterns of help-seeking.
For example, folk healers may be approached for folk diseases
and scientific healers sought for infectious diseases, wounds,
and refractory emotional disorders. These patterns for some
Hispanic Americans are discussed in Tharp and Meadow

24. (1973). Among urban Colorado Hispanic-American women,
20% had visited a curandero (folk healer) for treatment, and
12%
had taken one or more of their children for treatment (Rivera,
1988). These treatments are far from conventional psychologi-
cal treatments in form, and they may involve prayers, rest, rit-
ual, and the ingestion of herbs. Many progressive treatment
centers provide for cooperative work among scientific and folk
practitioners.
More than specific forms, there are presumptions and meta-
processes in the traditional treatment practices of many cul-
tures that are drastically different from values inherent in Euro-
pean and American mental health treatment. LaFromboise,
Trimble, and Mohatt (1990) provide an excellent description of
American Indian healing processes, in which "religion, physiol-
ogy, and psychology intertwine" (p. 632) and where traditional
healing encourages the client to transcend the ego by experienc-
ing self as embedded in and expressive of community. Tradi-
tional ceremonies reinforce adherence to cultural values and
remind participants of the importance of family and commu-
nity networks. Indeed, the family, kin, and friends coalesce into
an interlocking network to observe and understand and to inte-
grate the individual back into the social life of the group. Un-
like conventional psychological treatments, American Indian
healing ceremonies and procedures usually involve the client's
family and community members along with the healer and
client. This collective treatment of the entire network "heals"
not only the individual, but reaffirms the norms and solidarity
of the entire group (Kaplan & Johnson, 1964).
A third route toward cultural compatibility is to specifically
design treatment modalities on and for members of specific
cultures. An excellent example is cuento therapy, developed for
Puerto Rican children by Costantino, Malgady, and Rogler
(1986), but no doubt equally appropriate for other Hispanic

25. groups for whom cuentos (cautionary folktales) are familiar so-
cialization devices. In this technique, cuentos that were either
traditional or adapted to reflect current conflicts in American
life were read to high-risk kindergarten through third-grade
children by their (bilingual, bicultural) therapists and their
mothers, and a discussion was then fostered exploring the
meaning of the tale. Results indicated that cuento therapy sig-
nificantly reduced children's trait anxiety relative to traditional
therapy and to no intervention, and this trend was stable over 1
year. Cuento therapy also increased Wechsler Intelligence Test
for Children-revised (WISC-R) Comprehension subtest
scores. The authors discuss this technique as a modeling ther-
apy, which is attractive to the children because of the cultural
familiarity of the story characters, and as a cognitive develop-
ment task, useful because of the familiarity of the story-telling
modality itself. They also point out the relevance of the litera-
ture on cognitive and social development of disadvantaged mi-
nority children, who respond well to fairy-tale, story-telling
formats in classroom contexts. We should also note that the
involvement of the mothers is another feature highly recom-
mended by most students of Latin-American child treatment,
regardless of treatment modality.
Choice of Treatment Levels and Modalities:
Compatibility Through Context
However desirable specific-culture treatments are held to be,
it must be noted that very few have been designed and reported,
although the issue of cultural compatibility has been with us for
nearly 40 years. The history of the cultural compatibility move-
ment in education has a similar pattern. In spite of heroic ef-
forts, almost no culturally "invented" specific educational mo-
dalities have been designed to survive the practicalities of
schools. In the culture and education movement, most
compatibilities have been established through choosing estab-

26. lished modalities that per se allow for greater influence of the
child's culture, or at least do not demand incompatible child
behavior. The majority of mental health programs for minority
children in the literature appear to be using that same tactic: By
electing modalities that naturally include family and commu-
nity members and settings, some compatibility is assured by the
objective introduction of the cultural context. I will discuss
those modalities in an order that represents a rough progression
from lesser toward greater contextualization in the client's cul-
ture.
Psychotherapy
In the eyes of the public, individually conducted talking
treatment conducted by a professional is the paradigmatic
treatment form. Many clients of many cultures insist on receiv-
ing it because they have been convinced of its primacy and are
well aware of its elevated status. Indeed psychotherapy is not
per se ineffective for any culture (Sue, 1988); it can be made to
work for clients. For example, Paster (1985) makes a heroic
argument for the adaptations needed to psychodynamic psycho-
therapy so that it can be used with depressed, acting-out Black
male adolescents. Tyler, Sussewell, and Williams-McCoy
(1985)
address the issue of providing culturally sensitive services by
an
attempt to preserve the basic structure and concepts of psycho-
therapy while reconciling the universalist and particularist po-
sitions into a "transcendist" perspective of an "ethnic validity
model" that stresses that "persons from different ethnic/racial
backgrounds are psychosocially different but that under some
circumstances those differences can be transcended in ther-
apy" (p. 312).
With what reliability and regularity can therapists expect to
establish that transcendence? It appears to this writer that, be-

27. cause of two basic conditions, importing culture into individual
child psychotherapy is heavy freight indeed. First, individual
psychotherapy is a culturally specific form of treatment, just as
surely as is the sweat lodge or the herbalism of the curandero;
and second, of all the modalities at the command of the mental
health professions, individual psychotherapy most rigidly ex-
SPECIAL SECTION: CULTURAL DIVERSITY 805
eludes family or community members who might in feet import
the cultural context. In any event, the preponderance of writers
propose forms of treatment for minority children that struc-
turally involve participants who are themselves culture carriers.
Group Therapy
Kahn, Lewis, and Galvez (1974) reported a counseling pro-
gram for miscreant Papago Indian youth. The authors quickly
moved from an individual to a group therapy format, although
they improvised a number of changes to the usual confessional-
and-problem-sharing approach:
The cultural truth that Papagos are very reluctant to reveal per-
sonal and intimate details to others, particularly in a setting
with
their peers, appeared to be a major hurdle in developing much
group [therapy] interaction. It appeared that the main thing sus-
taining the group in early sessions was the money being paid for
attendance . . . [then] the therapists selected what they judged
would be a relevant problem or topic for these boys. The first
part
of the sessions [was] given to formal presentations.. . . How to
meet girls, venereal disease, homosexuality, drinking and
alcohol-

28. ism, the role of the male in the family, etc.. . . The boys would
talk about subjects or ask questions in the abstract or in terms
of a
third person." (Kahn, Lewis, & Galvez, p. 239-240)
The boys also confronted the [non-Indian] therapists about
their motivations and real reasons for working with them on the
reservation. They did develop regular attendance and much
improved arrest and school truancy rates.
Recourse to group treatment of children of cultures unfamil-
iar to the therapist can have many advantages, including the
socialization of new clients into an unfamiliar process, as well
as providing a socialization of the therapist into the client cul-
ture. Spurlock (1985) presents an instructive case in which a
White resident treats Black adolescents in just such a situation.
Problem Solving and Social Skills Training
Many writers recommend for Native American clients a
structured, problem-solving, skill-training approach, which
teaches through modeling and rehearsing those everyday skills
that are useful to Indian adolescents in adaptive living (e.g,
Long, 1983; Kahn et al, 1974; LaFromboise & Low, 1989; La-
Fromboise & Rowe, 1983; LaFromboise et al, 1990). Such pro-
grams have been successfully applied with Indian adolescents
to reduce substance abuse (Bobo, Cvetkovich, Gilchrist, Trim-
ble, & Schinke, 1987; Schinke et al, 1988), and adolescent sui-
cide (LaFromboise & BigFoot, 1988).
Globetti (1988) has reviewed alcohol education programs for
minority youth and concludes that similar programs are suited
for African-American and Hispanic youth as well. He does not
avoid the question of whether such an approach can be effective
without corresponding changes in family and neighborhood
conditions or without correction of the feelings of anomie, feel-

29. ings of oppression, marginal status, and the unemployment of
minority poverty. However, among Black, Hispanic, and Indian
minority communities, there are resources available for com-
munity treatment, including a strong abstinence sentiment es-
pecially among women and youth. A psychosocial skills ap-
proach reaches youth before they enter the age where drinking
patterns and attitudes become rigid. This approach emphasizes
values awareness and enhances self-esteem and a sense of self-
power through increasing abilities for stress reduction, decision
making, and behavioral alternatives such as assertiveness, re-
fusal skills, and social competency. Even minority youths in
effective social training groups for alcoholism prevention are
concerned with problem drinking by their family members.
Edwards and Edwards (1988) urge that Indian families be in-
volved, including nondrinking members and the extended fam-
ily
Family Therapy
Family therapy is often recommended by therapists and theo-
rists who are concerned to establish more compatible and more
effective treatment. Several considerations enter into this
broad-based recommendation. For example, consider that tan-
gle of racial attitudes, transferences, countertransferences, and
guilt that Greene (1985) cautions against in White treatment of
Black adolescents. Sykes (1987) recommends structured family
therapy (short-term, goal-directed) as a way of avoiding those
tangles, because the presence of the family establishes a Black
context in which the White therapist is a facilitator and in
which immediate problem solving is the focus.
The emphasis on extended family and on the individual as
part of a family in Asian culture is discussed by Chin (1983).

30. The Western view of family is more restrictive and based on the
nuclear family with the ultimate goal of a separation from the
family. The emphasis on nuclear family boundaries and
individual
"privacy" in Western families, when imposed on Asian-
American
families, often fails to appreciate the supportive networks,
social
cohesiveness, and sense of affiliation of the extended family.
The
diagnostic process needs to examine the indusiveness and inter-
dependence of kinship relationships in terms of how they might
facilitate the therapeutic process." (p. 107)
Because family therapy brings kin into the process itself, they
are less likely to be overlooked in the diagnostic process. In the
same way, family therapy mobilizes the available family re-
sources for impact on the situation of the child. Kim (1985)
endorses structured family therapy as the presumptive treat-
ment for children of Asian Americans and provides a valuable
discussion of the issues likely to arise in Asian families; merely
to resort to family treatment is no final escape for the therapist
from the need for cultural knowledge.
Structured family therapy was recommended by Inclan
(1985) for Puerto Rican and other Hispanic clients. Structural
family therapy was found to protect the integrity of the family
at 1-year follow-up, more than did psychodynamic child ther-
apy, although the two treatments were apparently equal and
superior to control conditions for 69 six- to twelve-year-old
His-
panic boys (Szapocznik, Rio, Murray, & Cohen, 1989).
Family therapy is recommended for Latin-American school
children by Vazquez-Nuttal, Avila-Vivas, and Morales-Barreto
(1984) because of the strong Hispanic emphasis on the family.

31. These authors recommend that the therapist explore the im-
portance of ethnic values and traditions to the family, the strain
between traditional family values and contemporaneous Ameri-
can life, intergenerational strains that are likely loci of these
value conflicts, and the extent to which the family relies on
neighborhood and school institutions.
806 ROLAND G. THARP
As Falicov and Brudner-White (1983) have discussed, the ac-
ceptance of the extended family as the unit of analysis reveals
vulnerabilities and sources of growth enhancement that are not
dreamed of in nuclear-family-based treatment tactics and the-
ories. Black families, even those of the stereotypical father-ab-
sent, unemployed-mother pattern, often have strengths and re-
sources in extended family and social networks that are com-
pletely overlooked by the therapist with a narrow view of
"family" (Spurlock, 1985). Juarez (1985) also discusses the best
fit for Hispanic children and recommends family therapy, but
also a form of megafamily treatment, "network therapy," a col-
laborative involvement of all significant members of the child's
social world.
temic interaction with those of the network members. Network
therapy is held to combat the depersonalization of the accultur-
ating, urban environment; and because it mobilizes the
strength of the support network, it contextualizes treatment
directly in the cultural nexus of family and community
members. Network therapy has been discussed as a specific
culturally consistent treatment and prevention approach for
American Indian communities (LaFromboise et al, 1990). In
Native Hawaiian communities, the entire network of family
and support participants are involved in a traditional process of
healing and reconciliation called hob'ponopono; Mokuau (1990)

32. has reported on the practice and its implications and possibili-
ties for the treatment of children.
Home-Based Treatment
Home-based programs embed treatment in a cultural
surround and thus are far less insulated from the influences of
home, family, and community. "The most well-documented,
effective therapeutic treatment with lower socioeconomic class
Blacks has been home-visiting programs aimed at supporting
and counseling mothers of young children" (Thomas &
Dansby, 1985, p. 400), particularly those such as described in
Gray and Ruttle (1980), that have positive effects on child lan-
guage development and a sustained improvement in mothers'
teaching styles. These criteria are well met by the carefully
evaluated home-visiting programs of Roberts and his asso-
ciates, working principally with Native Hawaiians (Roberts,
Wasik, Casto, & Ramey, 1991; Roberts & Magrab, 1991). These
authors rightly urge that culturally compatible programs must
be continually vitalized by a staff committed to the principle of
compatibility and influenced by community participation.
Even more deeply embedded in context is the Homebuilders
program, which trains, places, and supports professional
workers who become temporarily resident or quasi-resident in
the homes of their children clients, most of whom have already
been targeted for placement outside of the home (Kinney, Haa-
pala, & Booth, 1991). Although home-maintenance success
rates are impressive for all categories of children, children of
color had a significantly higher chance of remaining at home
during and after Homebuilders treatment than did their White,
non-Hispanic counterparts (Fraser, Pecora, & Haapala, 1991).
These data are consistent with the view that contextualization
of service is particularly critical for minority children.
Network Treatment

33. Network therapy (see Schoenfeld, Halevy-Martini, Hemley-
Van der Velden, & Ruhf, 198 5,1986, for descriptions and
evalua-
tions) involves a group of family, relatives, and friends who are
organized into a network. It is informal in operation. The thera-
pist's role is to catalyze and conduct the process, but the forces
of healing and correction are those of the support system of the
network itself. Ordinarily conducted in the home, it can include
50 people or more. Network therapy can be used for solving a
common or shared problem of the clan, family, or community,
or the network can be mobilized in response to the problem of a
single child or adolescent. Even in the latter case, the patient's
behaviors, experiences, and goals are understood in their sys-
Community Intervention
Contextuality may be seen as extending from family to ex-
tended family to community to the entire ecocultural niche.
Culturally oriented writers consistently call for an ecologically
oriented, contextualized analysis of psychological phenomena
and consequently a diagnosis and treatment scheme that lo-
cates the child in the sociocultural nexus—and indeed recog-
nizes that the intervention target for some child problems lies
in family, school, or community (Huang & Gibbs, 1989). Illus-
trating that critical difference, under new environmental con-
ditions of migration, displacement, or community change, the
family and the school themselves may become sources of stress
for the child and lose their value as social support networks
(Canino, Earley, & Rogler, 1980).
Ramirez (1980) discusses the complexity of family and com-
munity as problem/support units among urban Mexican Ameri-
cans. His study found that the propinquity and size of extended
family was positively related to mental health status among
Mexican Americans in Detroit. But nearness in time to Mexico

34. and markers of traditional culture were negatively related to
mental health status. Apparently an effective support structure
develops slowly, postmigration. It appears that as a family mi-
grates, it slowly develops a network, gains education, and im-
proves in mental health status. Furthermore, family support is a
structural phenomenon that operates in a mundane, solid, and
workaday manner: The presence of someone in the network
who offers "emotional understanding" and such "counselor-
like" qualities is unrelated to mental health status. Assisting a
referred child in a recent immigrant community may require
assisting a family, group of families, or entire community to
organize for mutual assistance.
An example of a developmentally oriented community psy-
chology program is that of OTJonnell and Tharp (1990), which
is based on the principles of neo-Vygotskian socio-historical
theory. In their analyses, the real client of the consultation is
the
social system that produces or maintains the problem. No per-
manent improvement in a child's condition can be expected
unless the sustaining context is also assisted to change. The
consultant must locate the levers of influence that can bring
about some reorganization. The ultimate goal of the consultant
is to empower and to increase the self-assistance of the commu-
nity and thus the growth or development of its members, partic-
ularly the referred child or children. The route to that goal is
through reorganization of activity settings. Through the pro-
SPECIAL SECTION: CULTURAL DIVERSITY 807
cesses of interaction and assisted performance in activity set-
tings, the targeted community members gain greater compe-
tence, skill level, and solidarity. The basic task of intervention
is

35. to design new or changed activity settings in which that growth
and development can occur. The influence of the consultant is
used to generate or organize the resources necessary to produce
those activity settings. The consultant, working in the triadic
model (Tharp & Note, 1988; Tharp & Wetzel, 1969), exercises
the consulting effects through mediators who are themselves
members of the settings or of the community context.
A fine example of such a program is that for prevention of
drug abuse by American Indian youth by the Indian Drug Pre-
vention Program (IDPP) of Washington State (Bobo et al,
1987). The consultants established an all-Indian advisory
board, worked with members to establish goals and guidelines,
developed together a curriculum of skills training (modeling,
instructing, and practicing), contacted gatekeepers of services
in six different communities, located venues and activity set-
tings in which the program could be operated, trained and
cooperated with local schools and other agencies, and left the
communities competent to carry out the positively evaluated
program. Other examples of similar community programs are
available in Edwards and Edwards (1988).
The IDPP operates primarily in schools. The movement to-
ward integrated mental health services in schools is particularly
important for cultural minorities. Red Horse (1982) described a
short-lived but well-conceived program that operated for In-
dian public school adolescent girls in Minnesota. It included
credit-bearing social skills training and psychosocial develop-
mental materials, cultural enrichment materials provided by
Indian elders, pregnancy prevention, group counseling, and a
professional staif of counselors who assisted the girls to bridge
and build extended family relationships both in the city and on
the nearby reservation. The creation of new activity settings
and the mobilization of resourcesof the family and community
to assist the performance of the adolescent girls is a model of
community program design. Another exemplary program is a

36. school psychology program for Hispanics that involves "sys-
tems networking among the nuclear and extended family, com-
padres, church personnel, indigenous support systems, and
school [which] affords pooling of human, informational, and
mental health resources for more effective, efficient, and eth-
nospecific services for Hispanics" (Rosado, 1986, p. 196).
Status of the Evidence for the Cultural
Compatibility Hypotheses
As we have now seen, there is virtual unanimity among
writers that some degree of compatibility between culture and
treatment is necessary. That unanimity, however, does not con-
clude the case. A useful understanding of compatibility requires
evidence that will allow unpacking the concept into its potent
and inert components. The necessary breadth of that evidence
is not yet present in the child-treatment literature. The absence
can be felt especially in the paucity of process studies of child
treatment, where interactions could be examined by charting
flows and glitches against the culturally based repertoires of
participants.
Evidence of that sort is present to a greater degree in the
study of child education. Although these parallel data can be
taken only as suggestive, they can help to formulate hypotheses
for research in the clinical and consulting context. In education
research on children, there is a substantial body of evidence
demonstrating cultural diversities in at least four domains that
make a difference in educational process and outcome: in lin-
guistics and sociolinguistics, cognition, motivation (state and
trait), and social organizational proclivities (reviewed in Tharp,
1989). As an illustration of the consequences for schooling,
effective monocultural classrooms for Native Indian children
have been shown to be markedly different from those for Native

37. Hawaiian children, in social organization, in patterns of child
control, in management of gender interaction, and in the pat-
terns of the teaching conversation between and among children
and teacher. As one example of an "unpacked" cultural vari-
able, sociolinguistic studies have demonstrated crucial differ-
ences in the courtesies and conventions of conversation for dif-
ferent ethnic groups, differences that have strong emotional
effects on children and condition the child's reaction to instruc-
tion, from willing engagement to hostile withdrawal.
Although this might be taken as evidence for the "strong"
cultural compatibility solution of designing classrooms for spe-
cific cultures, specific-culture classrooms are largely impracti-
cal. The typical classroom of our nation today is mwft/cultural.3
Of course, clinical services are not, and a variety of specific
culturally compatible services might be feasible within existing
service delivery institutional structures.
Before leaping to recommendations, however, we must note
in that same review of culture-and-education research (Tharp,
1989) considerable evidence for the weak or "two-type" form of
the hypothesis—that the children of all those cultures who typi-
cally underachieve in schools share the requirement for a modi-
fied kind of education that is not the same as that provided by
the majority-oriented schools. The educational research evi-
dence speaks for two conditions shared by successful
classrooms for children of underachieving minorities: (a) con-
textualization of learning activities into settings and topics that
are meaningful in the children's daily life and (b) assisting chil-
dren in developing the language of instruction, the latter assur-
ing the child of adequate participation in the learning activities.
These two factors are consistent with the evidence for child
treatment reviewed in this article: Contextualization of treat-
ment in the meanings and processes of cultural life is the most
insistent urging of all who work in child culture and mental

38. health. And logic dictates that treatment cannot be effective
unless it is delivered in a language the child and the family can
understand and use.
However, the universalist position does not lack evidence
either. For example, just as in the clinical domain, specific edu-
cational "treatments" growing from the institutions of specific
cultures have not emerged in any great number and in general
3 Certainly there are monocultural classrooms present in
society,
and these have been of great interest to researchers in culture
and
education because they allow cultural processes in teaching and
learn-
ing to emerge clearly. Likewise, investigating both process and
out-
come studies of various treatment modalities within a single
culture is
a research strategy of promise.
808 ROLAND G. THARP
have not survived the realities and necessities of schooling.
Rather, the cultural-compatibility movement in education ap-
pears to have settled on the least-change principle (Tharp et al.,
1984), which calls not for inventing entire new pedagogies or
teaching modalities, but for the careful selection of modalities
of demonstrated effectiveness in real schools and by working
teachers. The selection of such modalities may be quite differ-
ent for children of different cultures, and it is certain that the
instantiation of the modalities will be modified by contextua-
lizing them in the experience and language of the children's
daily lives. This appears to be entirely consistent with the expe-

39. rience of the more youthful culture-and-treatment movement.
Few specific treatment modalities have been offered. Certain
modalities, however, are overwhelmingly preferred by thera-
pists knowledgeable of certain cultures; and each instantiation
is recommended to be conditioned by the culture. Thus, family
therapy is repeatedly recommended for Hispanic children, but
the recommendation is equally strong that the family must be
treated in ways that reflect that family's composition, values,
and language.
On the basis of this discussion, it appears that the most via-
ble hypothesis is a universalist one, but not the "unrversalist"
hypothesis as previously understood. That is, clinical service
for everyone must be contextualized in the values, processes,
and language of the clients' culture, and that is the universalist
principle. Existing services are already contextualized for ma-
jority, English-speaking culture members because treatment
procedures grew out of that culture and language. Were it not
so, prescription would have to see to it.
When the strong, the weak, and the null forms of a hypothe-
sis are all verified, we know the question needs rephrasing.
Evidence and inference suggest the following as the best next
direction for investigation. Cultural compatibility, rather than
an accommodation needed for certain subsets of people, should
be understood as an aspect of a universally required contextua-
lization of services. The appropriate question would then be-
come: How can therapists, program developers, and re-
searchers develop heuristics for assuring the conditions of con-
text uality and language accessibility? Some previous inquiry is
available to that question.
Linguistic and Sociolinguistic Accessibility of Services
The problem of assessing and providing treatment across a
language barrier is central in the provision of services to chil-

40. dren of diverse cultures. This issue is most familiar to psychol-
ogy as an issue in testing: English-language interaction, in bi-
lingual children, is not a clear window through which cognitive
functioning can be estimated. And the problems associated
with attempting treatment when the therapist is not competent
in the basic language of the clients are formidable indeed.
In an effort to increase the linguistic accessibility, bilingual
and bicultural staff may be incorporated into the staff of men-
tal health facilities, as advocated early by Scott and Delgado
(1979). Acosta and Cristo (1981) describe a clinic for Hispanics
that recruited community members to serve as translators for
the English-speaking professional staff. Training was provided
in the basic concepts and vocabulary of psychotherapy. These
translators also served as cultural informants, explaining to the
therapists the meaning of some of the client's topics in therapy.
There is a danger, however, as pointed out by Lappin (1983),
in having a "house ethnic," often a paraprofessional, who is
called in to translate. Many individuals and cultural groups
want a professional regardless of race. In fact, there is a danger
in using any translator, who becomes a switchboard, a distorter,
and an additional principal in an already complex interaction.
Therapists must be cautious in using the most bilingual family
member as translator for all, particularly when this is the child,
who, while most flexible in language use may also be most
psychologically vulnerable to the dynamic forces of family and
therapist interaction. Nevertheless, there is evidence that pro-
vision of Spanish language opportunities in clinic programs
does increase utilization rates in Hispanic communities
(Rogler, Malgady, Costantino, & Blumenthal, 1987).
However, it is not simply language code proficiency that
creates misunderstandings and frustrations in cross-cultural
service delivery Differing Sociolinguistic and paralinguistic

41. patterns are barriers to communication. For example, Michaels
(1984) has shown that children of different cultures tell their
stories in different ways, with startling audience effects. In her
study, White children were topic-centered in their narratives,
with thematic cohesion and a temporal reference. Black chil-
dren used a topic-associating style consisting of a series of im-
plicitly associated anecdotal segments with no explicit state-
ment of an overall theme or point. White adults criticized the
topic-associating style as incoherent, but Black adults found it
interesting with lots of detail and description. It is apparent that
this cultural difference in basic language structure can lead to
quite different judgments and predictions in the treatment
room.
Process studies of cross-cultural treatment of children are
lacking. Again we must look to culture-and-education, where
such research is growing. A recent review (Tharp, 1989) reveals
that in determining relationship, learning, and satisfaction in
cross-cultural settings, there is enormous weight in variables of
the courtesies and conventions ofcomersation, such as the
length
of pause between speakers (wait-time), rhythm of speech and
event, and participation structures (the patterns and conditions
for speaking and listening). When Sociolinguistic school/home
compatibilities are present, children are more comfortable, and
they participate and display their abilities appropriately As one
example, Black migrant children, whose schools view them as
below grade level and unresponsive, speak and behave with
complexity and competence in home settings. In addition, they
exhibit full competence and full participation at church. The
similarities of Sociolinguistic and behavioral conventions be-
tween church and home offer an example to schools of how
formal institutions can engage their young by compatibilities of
expectations with child repertoires (Lein, 1975).
Many strategies have been devised for achieving linguistic

42. compatibility for children in schools. Because schooling is so
heavily language dependent, a first-order goal for effective edu-
cation is to provide adequate language development. This goal
is very likely parallel to child treatment, which is also a
learning
modality heavily dependent on language exchanges. To the de-
gree that treatment does occur through language, we may ex-
pect that special attention will be required to ensure linguistic
SPECIAL SECTION: CULTURAL DIVERSITY 809
and sociolinguistic compatibilities. This makes cross-cultural
psychotherapy particularly problematic for both therapist and
client. In the dimension of language, it seems clear that culture
members are indeed privileged, and same-language therapists
are advantageous to clients. However, when therapists do serve
clients of a different language, compensatory strategies are
available, the most powerful of which is to contextualize treat-
ment in the culture of the client. By importing other family and
community members into the treatment itself, familiar lan-
guage becomes a part of the treatment context.
Contextuality of Treatment
Sue and Zane (1987) observe that therapist/client cultural
matching is a distal variable and that efficacy lies in the proxi-
mal issues of how well the therapist is able to (a) meet the
client's conceptualization of the problem, (b) require acceptable
behaviors as means for problem resolution, and (c) share goals
for treatment. The literature considered here suggests that the
probability of those proximal conditions being achieved is lim-
ited by the degree to which social, linguistic, and other process
variables are congruent. There seems little doubt that all else
being equal, culturally matched psychologists and clients are

43. more likely to achieve that congruence and those conditions.
Most therapists can have little hope of sufficient detailed
knowl-
edge of many (if any) cultures other than their natal one and
almost no hope of mastering a variety of linguistic and socio-
linguistic codes. This leads us to consider the probability of
achieving process congruence and the Sue and Zane conditions
as a function of the modality of treatment.
Treatment modalities for children may be arrayed on a con-
tinuum of inclusiveness or social contextuality, from individual
psychotherapy to group therapy to family therapy to network
therapy to community intervention. Historically, these modali-
ties developed in roughly that order. Thus therapists of my own
(senior) cohort were trained, by and large, in the individual
model, with less intense training in groups, less still on fami-
lies, and little direct experience of network or community
methods, that is, with a decreasing emphasis on the expanding
continuum of social contextuality Although that pattern has
eased in many training programs during the past 30 years, there
is perhaps a residual tropism toward the individual end of the
continuum in the prescriptive inclinations of our field.
If the reading of the literature offered here is correct, a rever-
sal of that strategy is indicated. That is, for a therapist facing a
client across a cultural chasm, the treatment of first consider-
ation should be community intervention; that of second consid-
eration, network therapy; that of third, family treatment;
fourth, group treatment; and last of all, individual treatment.
The work of therapy is potent when the therapist and child
share so much that the therapist can presume a thorough knowl-
edge of the workings of the child's family and community and
can teach the youngster knowingly, confidently, and credibly
Because Euro-American culture has produced most therapists
and most clients, most clients and therapists have been

44. matched in culture and language. Insulated within a common
culture, we have not recognized cultural contextuality as a vari-
able because it has not varied. We have not noticed the basic
condition that because it is decontextualized, individual ther-
apy depends more than any other modality on shared values,
semiotics, habits, and expectations between therapist and
client. When these are not present, resources of commonality
have to be provided by expanding to family/network/commu-
nity interventions, even for majority culture members. It ap-
pears that the conclusions available from the culture and treat-
ment literature are not restricted to strategies for exotic culture
members. As we should have expected, an expanded range of
observations leads to a more comprehensive universalism. It is
paradoxical but welcome, that facing the problems of treating
others is teaching us how better to treat ourselves.
Implications for Research and Theoretical Programs
Humanity has a common base, provided by evolutionary
processes; but over long periods of historical time, ethnoge-
netic processes have put our common humanity through differ-
ent filters. To recover our common features, we must study
those filters and come to know how historical processes have
created differing psychological and behavioral realities for dif-
ferent peoples. These differences are not trivial, and they are
not surface. They include differences in motivation, cognition,
social organizational principles, communication patterns, val-
ues, and semiotic structures, as well as accustomed ways of
teaching and learning. Further research into ethnogenetic pro-
cesses is a necessity for advances in culture-and-treatment and
also holds promise for the discovery of a broader range of fun-
damental processes of psychology and sociology. This agendum
falls within the program of the sociohistorical theoretical move-
ment (e.g., Cole, 1985; Tharp & Gallimore, 1988; Vygotsky,
1929,1978; Wertsch, 1985).

45. On the other hand, just because we have been blind to "cul-
ture," we must not now be blinded by it. Each culture member
has also had a different life history and accumulation of learn-
ing. Thus ethnogenetic effects are filtered and conditioned by
ontogenetic and microgenetic processes; and in our rush to
solve problems of treatment arising from cultural differences,
we must not overlook the resulting wide range of variance
within cultures. Indeed the definitions and boundaries of eth-
nicities are under constant negotiation and redefinition (Do-
minguez, 1986). Psychology comes to the porch of cultural
stud-
ies just as the volatility of the concept of ethnicity is coming
into focus, and although belated, our arrival may well be wel-
comed by the house of social science. Individuals define them-
selves in and out of ethnic identities, and that psychological
identification is of more moment in treatment issues than is
that of race. Psychologists have the means to understand those
processes and how they operate in and through psychological
treatment.
Another major research need lies within the field of clinical
and consulting psychology itself. The paucity of process studies
in the treatment of different culture members, particularly in a
variety of modalities, is the greatest single need for evidence.
Critical data and its analysis will require methods of investiga-
tion less familiar to psychology than they might be, methods
such as ethnography, microethnography, and discourse analy-
sis. Expanding our range of research operations need not await
major retooling of psychologists' methodology. Research part-
nerships made with scientists of other appropriate disciplines,
810 ROLAND G. THARP

46. such as sociolinguistics, anthropology, or community develop-
ment, could allow an immediate infusion of data that reveal
cultural processes in their immediacy and at their points of
impact—in the situations and communications of treatment
itself.4
Are there immediate, imperative, specific hypotheses for in-
vestigation? Certainly all conclusions offered above have the
status of hypothesis. As much as on direct evidence, this analy-
sis perforce relied on reasoning and analogy. My strategy was to
suggest the figure in the ground by putting those tiles in the
mosaic as placeholders, pending the arrival of more direct evi-
dence drawn from the treatment of children. About the figure
that will eventually be clear, there is one thing that now appears
certain. These cultures meeting in the consulting room will
clarify not only the processes of the cultures themselves, but
will bring to our notice things about treatment that we do not
yet suspect.
4 As an example of how this strategy was used in the culture-
and-

47. educational domain, see Tharp et al. (1984).
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Received January 9,1991
Revision received May 3,1991
Accepted May 15,1991 •
CHAPTER FOURTEEN: Juvenile Corrections: Probation,
Community Treatment, and Institutionalization
CHAPTER OUTLINE
JUVENILE PROBATION

68. · Historical Development
Expanding Community Treatment
Contemporary Juvenile Probation
Duties of Juvenile Probation Officers
PROBATION INNOVATIONS
· Intensive Supervision
Electronic Monitoring
Restorative Justice
Balanced Probation
Restitution
Residential Community Treatment
SECURE CORRECTIONS
· History of Juvenile Institutions
What Does This Mean to Me?
JUVENILE INSTITUTIONS TODAY: PUBLIC AND PRIVATE
· Population Trends
Physical Conditions
THE INSTITUTIONALIZED JUVENILE
· Male Inmates
FOCUS ON DELINQUENCY: Mental Health Needs of Juvenile
Inmates on the Rise
Female Inmates
CORRECTIONAL TREATMENT FOR JUVENILES
· Individual Treatment Techniques: Past and Present
Group Treatment Techniques
Educational, Vocational, and Recreational Programs
Wilderness Programs
Professional Spotlight: Kristi Swanson
Juvenile Boot Camps
THE LEGAL RIGHT TO TREATMENT
· The Struggle for Basic Civil Rights
JUVENILE AFTERCARE AND REENTRY
· Supervision
JUVENILE DELINQUENCY: Treatment: Using the Intensive
Aftercare Program (IAP) Model
Aftercare Revocation Procedures

69. FUTURE OF JUVENILE CORRECTIONS
LEARNING OBJECTIVES
After reading this chapter you should:
· 1. Be familiar with juvenile probation.
· 2. Know about new approaches for providing probation
services to juvenile offenders.
· 3. Understand past and current trends in the use of juvenile
institutions and key issues facing the institutionalized juvenile
offender.
· 4. Be able to identify current juvenile correctional treatment
approaches and comment on their effectiveness in reducing
recidivism.
· 5. Know about aftercare and reentry for juvenile offenders.
REAL CASES/REAL PEOPLE: Karen’s Story
Karen Gilligan, age 16, was the oldest of four children living
with their parents in a small rural community. Her mother
worked two jobs, her father was unemployed, and both parents
drank heavily. Karen’s high school attendance was sporadic.
She started to experiment with alcohol and vandalized local
businesses. After being arrested in a stolen car on several
occasions, Karen was referred to juvenile court and was put on
community supervision and probation. An initial assessment
was provided by her probation officer, and formal dispositional
recommendations were made to the court. She would remain at
home on house arrest for 60 days, attend school regularly and
maintain at least a C average, follow an alcohol and drug
assessment program, and participate in weekly family therapy
with her parents. Karen was also ordered to cooperate with the
juvenile restitution program, pay her restitution in full within
six months, and participate in the Community Adolescent
Intensive Supervision Program, as arranged by her probation
officer.
Not used to being accountable to anyone, Karen struggled
initially with all the new rules and expectations. She missed
some of her initial appointments and skipped some classes at
school. Karen’s probation officer began making unannounced