Issues in Multicultural Correctional Assessment and Treatment By Corinne N. Ortega Introduction Increasing diversity in the United States has widened the base populations to whom psychologists provide services. Various divisions of the American Psychological Association (APA) have recognized the importance of multicultural competencies for more than 25 years (notably, Division 17—Counseling Psychology and Division 45—The Society for the Psychological Study of Ethnic Minority Issues). In 2002, APA formally recognized the evolution of the science and practice of psychology in a diverse society by adopting as policy the Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists (APA, 2002b). Nowhere is the changing face of the United States reflected more clearly than in its correctional systems. Blacks and Hispanics make up 62% of the incarcerated population, although they comprise only 25% of the national population (Human Rights Watch, 2002). Hispanics represent 40% of all sentenced federal offenders, although they account for only 13% of the total U.S. population (López, 2000). According to the Bureau of Justice Statistics (2007), the lifetime chance of a person going to prison is higher for Blacks (18.6%) and Hispanics (10%) than for Whites (3.4%). Furthermore, Blacks represent approximately 40% of the death row population in the United States (Amnesty International, 2003). The sociopolitical and socioeconomic explanations for this phenomenon are complex and far beyond the scope of this chapter. It is clear, however, that given the disproportionate confinement of minorities in the United States, any meaningful discussion of correctional mental health must necessarily include a discussion of multicultural issues. This chapter will first focus on a general overview of multicultural counseling and its applications in correctional settings. Second, the use of psychological tests and assessments with multicultural correctional populations will be explored with an emphasis on forensic evaluations. Finally, the issue of cultural competence with religious minorities and religious extremists will be addressed. Multicultural Counseling Jackson (1995) succinctly defines multicultural counseling as counseling that takes place between or among individuals from different cultural backgrounds. Although a simple enough definition, the implications of this in the mental health field are far-reaching. The increased racial, ethnic, and cultural diversity in the United States creates a demand for professional services, including mental health, that meet the needs of people from a wide variety of backgrounds (Barrett & George, 2005). The issues involved in providing culturally competent services are as complex and varied as clients themselves (Sue & Sue, 2007). Cookbook approaches to multicultural counseling cannot be utilized without contradicting the very concept. López (2000) discusses this in terms .

1. Issues in Multicultural Correctional Assessment and Treatment
By Corinne N. Ortega
Introduction Increasing diversity in the United States has
widened the base populations to whom psychologists provide
services. Various divisions of the American Psychological
Association (APA) have recognized the importance of
multicultural competencies for more than 25 years (notably,
Division 17—Counseling Psychology and Division 45—The
Society for the Psychological Study of Ethnic Minority Issues).
In 2002, APA formally recognized the evolution of the science
and practice of psychology in a diverse society by adopting as
policy the Guidelines on Multicultural Education, Training,
Research, Practice, and Organizational Change for
Psychologists (APA, 2002b). Nowhere is the changing face of
the United States reflected more clearly than in its correctional
systems. Blacks and Hispanics make up 62% of the incarcerated
population, although they comprise only 25% of the national
population (Human Rights Watch, 2002). Hispanics represent
40% of all sentenced federal offenders, although they account
for only 13% of the total U.S. population (López, 2000).
According to the Bureau of Justice Statistics (2007), the
lifetime chance of a person going to prison is higher for Blacks
(18.6%) and Hispanics (10%) than for Whites (3.4%).
Furthermore, Blacks represent approximately 40% of the death
row population in the United States (Amnesty International,
2003). The sociopolitical and socioeconomic explanations for
this phenomenon are complex and far beyond the scope of this
chapter. It is clear, however, that given the disproportionate
confinement of minorities in the United States, any meaningful
discussion of correctional mental health must necessarily
include a discussion of multicultural issues. This chapter will
first focus on a general overview of multicultural counseling
and its applications in correctional settings. Second, the use of

2. psychological tests and assessments with multicultural
correctional populations will be explored with an emphasis on
forensic evaluations. Finally, the issue of cultural competence
with religious minorities and religious extremists will be
addressed.
Multicultural Counseling Jackson (1995) succinctly defines
multicultural counseling as counseling that takes place between
or among individuals from different cultural backgrounds.
Although a simple enough definition, the implications of this in
the mental health field are far-reaching. The increased racial,
ethnic, and cultural diversity in the United States creates a
demand for professional services, including mental health, that
meet the needs of people from a wide variety of backgrounds
(Barrett & George, 2005). The issues involved in providing
culturally competent services are as complex and varied as
clients themselves (Sue & Sue, 2007). Cookbook approaches to
multicultural counseling cannot be utilized without
contradicting the very concept. López (2000) discusses this in
terms of culturally critical thinking. Multicultural awareness
allows the counselor to think about diversity in nonjudgmental
ways without polarizing issues into “right and wrong” and
should take into consideration all of the complex dimensions of
clients in a pluralistic society (Corey & Corey, 1998).
Unidimensional concepts of race, ethnicity, and culture allow
practitioners to conceptualize their clients as having more than
just a singular notion of self. Most people have more than just
one definition of who they are. People often define themselves
by criteria such as gender, race, ethnicity, sexual orientation,
socioeconomic status, citizenship, and religious affiliation.
Multicultural counseling is the understanding that individuals
exist and behave in a larger context that includes all of these
notions of self. Indeed, cultural identity is fluid and often
changes according to social context (Monk, Winslade, &
Sinclair, 2008). A complex undertaking is made more
challenging with the realization that cultures are not static and

3. should be understood in terms of their own dynamic processes
(López, 2000).
Multicultural counseling competency is the ability to understand
and conceptualize a client through multiple worldviews, the
ability to see the ways in which clients’ cultural experiences
may or may not influence their presenting problems, the clients’
understanding of the source of their problems, and the
understanding of what it will mean for the problems to be
adequately addressed through the counseling process. The
conceptualization of multicultural counseling competency
understood in this light becomes, to coin a phrase, not a
destination, but a journey. To make matters more confusing,
there are many ways in which to define mental health. The
Diagnostic and Statistical Manual of Mental Disorders–Fourth
Edition, Text Revision (DSM-IV-TR; American Psychiatric
Association, 2000) recognizes this by stating,
A clinician who is unfamiliar with the nuances of an
individual’s cultural frame of reference may incorrectly judge
as psychopathology those normal variations in behavior, belief,
or experience that are particular to the individual’s culture. For
example, certain religious practices or beliefs (e.g., hearing or
seeing a deceased relative during bereavement) may be
misdiagnosed as manifestations of a Psychotic Disorder.
Applying Personality Disorder criteria across cultural settings
may be especially difficult because of the wide cultural
variations in concepts of self, styles of communications, and
coping mechanism. (p. xxxiv) Likewise, the DMS-IV-TR
recognizes the term culture-bound syndrome, which “denotes
recurrent, locality-specific patterns of aberrant behavior and
troubling experience that may or may not be linked to a
particular DSM-IV diagnostic category” (p. 898). The DSM-IV-
TR goes on to suggest that culture-bound syndromes are
generally limited to specific cultural areas. Thus, abnormal or
psychopathological behaviors should be viewed in their cultural
context (see Table 6.1 for examples of culture-bound
syndromes).

4. Table 6.1 Culture-Bound Syndrome Source: Adapted from
American Psychiatric Association (2000); see also Paniagua
(2000). People from various cultures and backgrounds will also
approach and respond to the therapeutic process differently. For
example, Gonzalez (1997) notes that traditional Hispanic
Americans are accustomed to being treated by physicians and
may be unclear as to the role of a psychologist or other mental
health provider, expecting medication and a quick solution to
their problems. African Americans may be distrustful of the
counseling process, based on historical hostility due to their
prolonged inferior treatment by American society (Evans &
George, 2008). They may prefer to use prayer, faith,
spirituality, and religious figures to assist with personal
problems (Toldson, 2008). Asian Americans tend not to seek
psychological services and tend to terminate prematurely when
they do (Kim & Park, 2008), as there is a cultural norm against
sharing private matters with outsiders (Sue & Sue, 2007).
Furthermore, in some Southeast Asian countries, a mental health
problem is considered the same as being insane and is an
admission of inferiority (Nguyen, 1985), thus reducing the
likelihood of seeking treatment. Communication styles also vary
widely across racial and ethnic groups. For example, African
Americans may speak loudly and be more animated than their
non–African American counterparts (Evans & George, 2008).
Asian Americans may communicate through indirect means, use
apology to maintain and build “face,” acknowledge and defer to
hierarchy, be more modest and allow for more silence, and place
a high value on emotional control and stoicism (Kim & Park,
2008). Native Americans may emphasize nonverbal
communication and avoid direct eye contact out of respect for
an elder or person in authority (Garrett, 2008). Multicultural
Applications in Corrections Correctional mental health is
practiced in a fast-paced environment and requires specialized
training focused on the unique needs of the criminal population.
This challenge is increased when it is also necessary to apply

5. the principles of multicultural counseling to the offender
population. Criminal offenders are as diverse as the racial,
cultural, and socioeconomic backgrounds from which they
come. The APA Ethical Principles of Psychologists and Code of
Conduct (2002a) mandates that psychologists practice only in
areas in which they maintain competence and, unless it is an
emergency, refer clients with whom they do not have the
necessary understanding of racial, socioeconomic, cultural,
ethnic, and/or other issues essential to providing services. The
ethical codes of the American Counseling Association and the
National Association of Social Workers have similar
expectations for providing services to diverse populations.
Although this is a noble aspiration, it may be impractical at best
and impossible at worst in a correctional setting. Imagine that a
new inmate, who was recently arrested at an international
airport, arrives at a facility. The inmate is from South Africa
and speaks Bantu. He reports he is part of the Lemba tribe.
After tackling the first challenge of finding a translator, cultural
competence requires an understanding of this inmate’s
background. Where does a clinician start—with his South
African culture or with his tribal background? How many
clinicians know anything about the Lemba tribe? In the absence
of this cultural information, the APA ethical guidelines say that
psychologists must refer the client to someone who does know
about the tribe. How likely is it that there will be another
clinician in the institution who is familiar with the Lemba tribe?
(See Lerner & Lerner, 2006, for more information about the
Lemba tribe). The pragmatic issues of referring are obvious.
Just as unrealistic is trying to become educated and trained in
every cultural group and all of their variations. To make matters
more confusing, the issue of prison culture must also be
considered. Brodsky (1975) describes the process of adapting to
the prison culture as prisonization. The prison subculture has its
own set of values and beliefs, which are different from the
culture of the communities and families from which inmates
come (Gordon, 1999). So, what is the solution? As with most

6. aspects of correctional mental health, the key to successfully
navigating the maze of cultural competence lies in flexibility.
McAuliffe (2008) suggests three broad guidelines for flexibility
in working with culture: recognizing the fluidity in culture;
making measured, tentative generalizations; and adapting
traditional counseling theories to cultures, but doing so flexibly.
Individuals from the same racial, ethnic, and/or cultural
background will have tremendous variability in the degree to
which they adhere to those values. The culturally competent
correctional mental health practitioner must balance an
awareness of the variety of cultural influences prisoners bring
with them to the correctional institution. They must also have
an understanding of the impact of the prison culture and the
ways in which prisonization modifies behavior as individuals
adapt to their incarceration. Finally, they must attempt to
provide meaningful interventions and services that are both
culturally competent and appropriate to address underlying
criminogenic tendencies such as antisocial and narcissistic
beliefs and attitudes and criminal thinking errors (e.g., “I’m not
hurting anyone” and “Everybody does it, they just don’t get
caught”). As one can imagine, this is not an easy task, as the
following sample case study illustrates.
Composite Case Study Reason for Referral “M” was referred to
mental health services by another staff member. The staff
member reported that during routine phone monitoring of
inmate calls, M was overheard being informed of his mother’s
unexpected death in an auto accident. The staff member
requested that mental health staff offer services to M based on
his recent loss. Background M is a 33-year-old Black male. He
is currently serving a 10-year sentence for armed robbery. This
is his second adult felony. His arms and neck are heavily
covered in gang tattoos. He has a few institutional disciplinary
infractions for gambling. Other than a routine intake screening,
he has had no contact with mental health services during his
incarceration. Findings Because it was unclear if M wanted or

7. desired mental health services, he was seen briefly on his unit.
He was called into a private office on the unit. The door to the
office had a window that faced the common area. M came into
the office and closed the door. Although his back faced the
window of the door, he left one hand on the doorknob, as if
preparing to leave. He initiated the conversation by stating,
“What you need? I didn’t ask for no Psych.” He was informed
that it was a routine visit to offer services in light of his
mother’s passing. He stated, “I don’t need nuthin.’ I’m
straight.” A final attempt was made to engage M by offering
him condolences and expressing that it must be very hard for
him to have lost his mother so unexpectedly, especially while he
is incarcerated. At this point, M’s eyes began to tear up, and it
appeared as though he might cry. Cognizant that the interview
was still on the unit and in the presence of his peers, he was
offered the opportunity to be taken to a private office off of the
unit. M declined and continued to stand with one hand on the
doorknob. However, M began to discuss the difficulty of his
mother’s loss, and he was provided with supportive counseling.
When offered the opportunity to come to the mental health
department at a later date to talk further, he declined. However,
when asked if it would be okay if a mental health clinician came
back to the unit to check on him, he stated that would be
“alright.” He was provided with an additional session that
occurred in much the same manner as the first, with his hand
never leaving the doorknob.
Discussion Understanding the dynamics of this encounter
requires viewing the situation from multiple lenses. First, the
presenting issue of bereavement takes many forms. People
grieve differently, and talking is not necessarily helpful to
everyone. So, M’s initial response that he was not interested in
services is not indicative of anything in particular. However, as
a Black male, multicultural awareness requires cognizance of
the fact that M may have some inherent distrust of the mental
health system. Therefore, it is possible that he may desire
services but is apprehensive of availing himself of them.

8. Finally, M’s affiliation with the prison culture must also be
considered. As a second-time felon, he is a more experienced
inmate. His tattoos indicate he has led an antisocial and
criminal lifestyle. Thus, he is less likely to view services
established by “the man” as something useful to him.
Additionally, to “save face” with other inmates on the unit, he
needs to minimize his emotions regarding his mother’s death
and appear to remain “strong” by rejecting offers of help. By
standing at the door with his hand on the doorknob, M gave the
appearance to others on the unit that he did not want to be there
and, in fact, was “trying” to leave the office. This shifted the
responsibility onto the mental health staff for “keeping” him
there, rather than his desire for services. Choosing to stay on
the unit also sent a clear message to his peers that he was not
voluntarily going anywhere with mental health staff. Because
his back was to the unit, he was able to express himself, without
being seen, while giving the impression that he did not want to
be talking to the clinician.
Exercises 11-4NameExercises 11-4 SectionDateE11-4Lachlin
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