Exploring the Cognitive Process and Complexity of Diverse Patient Conceptualization: A Mixed Methods Study

In an era when culture is valued in therapy, the field has increasingly emphasized therapist competence in working with diverse clients and reducing mental health disparities (Bernal, Jimenez-Chafey, & Rodriguez, 2009). While there are multiple aspects of multicultural competence (e.g., choosing assessments with appropriate norming groups, consulting with members of the client’s culture, culturally sensitive therapy practices), case conceptualization is believed to be a crucial competence to providing effective services to clients who are racial or ethnic minorities (Hill, Vereen, McNeal, & Stotesbury, 2013). These skills allow the therapist to integrate client culture into their understanding of the client and may help improve treatment outcomes (Ridley & Kelly, 2007). Despite the potential importance of multicultural case conceptualization skills, there has been little empirical research to date on these skills. The present study sought to examine the content and quality of multicultural case conceptualizations and how the training experiences of trainees influenced the development of their multicultural conceptualization skills. A mixed methods approach was used to gain qualitative and quantitative insight into the nature of multicultural client conceptualizations among trainees, with a primary emphasis on qualitative methodology. Eleven trainees engaged in a think-aloud task through which they created a multicultural case conceptualization of a diverse client with whom they had worked in therapy. Additionally, trainees were interviewed regarding their experiences learning multicultural case conceptualization skills. Foremost, trainees described several topics related to the clients racial or ethnic background and discussed why they believed the client’s culture was pertinent to that particular case. Further, trainees described both facilitative and challenging experiences as they learned multicultural case conceptualization skills. Limitations and implications for training and research are discussed. The study concludes with an exploration of future research directions to address gaps in the literature on multicultural case conceptualization skills