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journal of Multicultural counseling and developMent • July 2015 • Vol. 43 173

© 2015 American Counseling Association. All rights reserved.

Received 11/12/12 Revised 07/19/13

Accepted 12/09/13 DOI: 10.1002/jmcd.12013

Competent Counseling for Middle Eastern American Clients:

Implications for Trainees Sepideh S. Soheilian and Arpana G. Inman

The authors used a factorial multivariate analysis of variance (MANOVA) to determine whether counselor trainees’ group differences on measures of multi- cultural competence, empathy, and multicultural counseling self-efficacy (CSE) when working with Middle Eastern American (MEA) clients were moderated by trainee race. Two hundred and fifty-six trainees responded to 3 different clinical vignettes that gave information on clients who had varying degrees of MEA characteristics. MANOVA results revealed a significant main effect for trainee race. Follow-up analyses demonstrated that trainees of color reported higher multicultural competence and multicultural CSE than White trainees.

Keywords: multicultural, cultural competence, Middle Eastern Americans

Los autores usaron an análisis factorial multivariante de la varianza (MANOVA, por sus siglas en inglés) para determinar si las diferencias en grupos de consejeros en formación respecto a competencia multicultural, empatía y autoeficacia en consejería (CSE) multicultural al trabajar con clientes ameri- canos con ascendencia de Oriente Medio (MEA) estaban moderadas por la raza del consejero. Doscientos cincuenta y seis consejeros en formación respondieron a 3 viñetas clínicas que ofrecían información sobre clientes que tenían diversos grados de características de MEA. Los resultados del MANOVA revelaron un efecto principal significativo para la raza del conse- jero. Análisis de seguimiento demostraron que los consejeros de color en formación comunicaron un mayor nivel de competencia multicultural y CSE multicultural que los consejeros blancos.

Palabras clave: multicultural, competencia cultural, americanos con ascen- dencia de Oriente Medio

The rapidly changing demographics of the United States within an in-creasingly multicultural society have challenged counselors to provide services to greater numbers of racial and ethnic minority clients. Given this, the American Psychological Association (APA) has provided guidelines for multicultural competence that urge psychologists to adhere to minimum practices that are appropriate for working with diverse clients (APA, 2003). In addition to multicultural competence, empathy and counseling self-efficacy (CSE) have been highlighted as important counselor characteristics for work- ing with clients from diverse cultural backgrounds (Constantine, 2000; Sue & Sue, 2008). Additionally, studies that have investigated counselor multicul- tural competence with diverse client populations have revealed differences

Sepideh S. Soheilian and Arpana G. Inman, Department of Counseling Psychology, Lehigh University. Sepideh S. Soheilian is now at Counseling Center, Loyola University Maryland. Correspondence con- cerning this article should be addressed to Sepideh S. Soheilian, Counseling Center, Loyola University Maryland, 4501 North Charles Street, Baltimore, MD 21210 (e-mail: [email protected]).

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between White trainees and trainees of color on subscales of multicultural competence (Chao, 2006; Chao, Wei, Good, & Flores, 2011; Hill, Vereen, McNeal, & Stotesbury, 2013; Ponterotto et al., 1996; Pope-Davis & Ottavi, 1994; Vinson & Neimeyer, 2000, 2003). One cultural group for which there is limited counseling competence literature is Middle Eastern American (MEA) clients (sometimes referred to as Arab Americans in the literature). Historically, the U.S. government and media have negatively portrayed MEAs. Today, these two powerful sociopolitical forces continue to influence negative biases and stereotypes toward MEAs, which have resulted in greater anxiety, depression, and acculturation stress for this population (Amer, 2005). Although theoretically based guidelines exist for counseling MEAs (Jackson & Nassar-McMillan, 2006), empirical research in this area is limited. Because of the lack of empirical research on MEA clients and the importance of cultur- ally competent counseling interventions for this population, the purpose of the current study was to use clinical case vignettes to explore the differences between White trainees and trainees of color in counselor multicultural com- petence, empathy, and multicultural CSE for working with MEAs who varied by MEA characteristics. The use of case vignettes was adapted from previous studies that incorporated clinical vignettes to assess the multicultural case conceptualization ability of trainees of color and White trainees for working with a client of color (Constantine & Ladany, 2000; Inman, 2006; Ladany, Inman, Constantine, & Hofheinz, 1997).

meas MEAs are defined as descendants of countries located in the Middle East, which include Bahrain, Egypt, Iran, Afghanistan, Iraq, Israel, Kuwait, Lebanon, Oman, Palestine, Qatar, Saudi Arabia, Sudan, Somalia, Syria, Turkey, the United Arab Emirates, and Yemen (Soheilian & Inman, 2009). The Arab American Institute (2008) reported that the total population of Arab Americans living within the United States is 3.5 million. Population figures from the Arab American Institute can be more reliable than those of the U.S. Census because the or- ganization obtains demographic information from people who self-identify as Arab American and represent Arab ethnicities from multiple Arab/Middle Eastern countries. According to the U.S. Census Bureau (2000), MEAs are classified as White, and thus are ignored as a culturally diverse population. MEAs experience unique challenges that clinicians should be aware of and integrate into their practice when working with these clients (Soheilian & Inman, 2009). Specifically, MEAs can experience discrimination as a result of their ethnicity and/or religious affiliation with Islam (Bozorgmehr & Bakalian, 2008; Forstenlechner & Al-Waqfi, 2010). Discriminatory behaviors against Muslims, who make up about 50% of MEAs, often result from others’ perceived differences with regard to Muslims’ wardrobe, ways of life, tradi- tions, and religious practices (Forstenlechner & Al-Waqfi, 2010). In an effort to avoid being the target of hostility, many MEAs have been cautious about

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qualities that may draw negative attention to them, such as their wardrobe or name (Sue & Sue, 2008). The limited empirical literature emphasizing MEA mental health suggests that MEAs struggle with psychological distress in the form of anxiety, depres- sion, acculturation stress, and low self-esteem in relation to acts of discrimina- tion (Amer, 2005; Moradi & Hasan, 2004). In their study that explored the relationship between discrimination and mental health with Arab Americans, Moradi and Hasan (2004) found a direct link between perceived discrimina- tion and psychological distress. Moradi and Hasan’s research suggested that perceived discrimination events was related to lower levels of control in one’s life, which, in turn, was related to lower self-esteem and greater psychologi- cal distress for Arab Americans. Amer (2005) noted that following the World Trade Center attacks, Arab Americans reported greater anxiety, depression, and acculturation stress. She further noted that acculturation stress correlated with anxiety and depression. Hassouneh and Kulwicki (2007) conducted a pilot study with 30 Arab Muslim women living in the United States, and the researchers’ results suggested that the women were at risk for acculturative stress, discrimination, and related psychological distress. Relatedly, in their study of 350 Muslim Arab Americans, Abu-Ras and Abu-Bader (2009) found significantly high levels of posttraumatic stress disorder and depression, which the authors contributed to Muslim Arab Americans’ experiences with living in a hostile post–September 11 anti-Arab climate. The combination of living in a toxic environment in conjunction with the barriers to help seeking, such as the stigma of seeking mental health counseling for MEAs (Soheilian & Inman, 2009), indicates a need for effective, culturally competent counseling interventions for this group. The current study prompts the mental health field to both explore counselor variables of multicultural competence, empathy, and multicultural CSE when working with MEA clients and expand existing multicultural competence literature to include a focus on MEA clients.

multicultural counseling competency Empirical literature with a focus on multicultural counseling competency with MEAs is limited. In a survey study conducted by Sabbah, Dinsmore, and Hof (2009), the authors concluded that although counselors perceive multicultural competence with MEAs as important, they lack knowledge of the worldview of MEAs and perceive themselves as less competent in working with MEAs when compared with other racial and ethnic minorities in the United States. In their guidelines for working with Arab Americans with disabilities and their families, Al Khateeb, Hadidi, and Al Khatib (2014) outlined culturally appropriate counseling considerations when working with this population, such as family considerations, help-seeking behaviors, and stereotypes. For the purpose of this study, multicultural competence has been defined in accordance to Sue and Sue’s (2008) theory of multicultural competence.

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Sue and Sue outlined three major competency areas for counselors that contribute to the development of counselor multicultural competence: knowledge (e.g., understanding the worldview of others), awareness (e.g., counselor’s understanding of his or her own biases and stereotypes toward other groups), and skills (e.g., counselor’s ability to incorporate culturally appropriate interventions with the client). Demonstrating multicultural com- petence with clients can strengthen a working alliance and lead to an overall positive therapy experience (Constantine, 2001b, 2002; Constantine & Ladany, 2000, 2001; Fuertes & Brobst, 2002; Fuertes et al., 2006; Inman, 2006; Ladany et al., 1997). Therefore, expanding the multicultural competence research to include counseling competencies with MEAs is a valuable addition to the counseling literature.

trainee race and multicultural competence

A majority of studies that have assessed multicultural competence indicated that counselors of color scored significantly higher than White counselors across a number of subscales that measure counselor awareness, knowledge, and skills in clinical work with diverse clients (Chao, 2006; Chao et al., 2011; Hill et al., 2013; Ponterotto et al., 1996; Pope-Davis & Ottavi, 1994; Vinson & Neimeyer, 2000, 2003). For example, in their initial scale development of the Multicultural Awareness Scale, Ponterotto and colleagues (1996) found that when they combined trainees of color into one group, trainees of color scored significantly higher than White trainees on the Knowledge and Skills subscales. Similarly, Pope-Davis and Ottavi (1994) assessed racial differences in multicultural competence among a sample of 220 university counseling center counselors. Participants responded to self-report questions that assessed multicultural knowledge, awareness, skills, and relationships. Results indicated that Asian American and Hispanic counselors reported greater multicultural knowledge than did White counselors. Pope-Davis and Ottavi also found that African American, Asian American, and Hispanic counselors reported more competence in multicultural awareness and relationships than did White coun- selors. Similar to these findings, in a study of group differences on self-perceived multicultural competence, Hill and colleagues (2013) found that both African American and Hispanic counselor trainees scored significantly higher on self- reports of general multicultural competence than did White counselor trainees. Furthermore, studies that used trainee self-reports of multicultural competence revealed that Whites scored significantly lower on the Knowledge and Skills subscales of multicultural competence (Vinson & Neimeyer, 2000, 2003). Chao (2006) conducted a study that investigated the relationship between multicultural counseling competence and counselor race, multicultural train- ing, ethnic identity, and color-blind racial attitudes of graduate students in counselor education and counseling psychology programs. Through the use

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of hierarchical regression models, Chao found that at the second step of the model, when added to social desirability, counselor race was found to con- tribute significantly to the variance in counselor multicultural competence. This finding suggests that there is a relationship between counselor race and counselor multicultural competence. The current study asked participants to imagine themselves as a counselor for a specific client and report their multicultural counseling competence with respect to that client. Additionally, a main purpose of this study was to investigate if differences in multicultural competence scores between case vignettes were moderated by trainee race.

empathy and counseling competence Davis (1980) proposed a multidimensional model of empathy that included both cognitive and affective components. He described cognitive empathy as perspective taking and the ability to adopt the viewpoint of others and imagine the feelings of others. Davis described affective empathy as empathic concern for others or other-oriented feelings of sympathy. The multicultural competency literature has examined the role of counselor empathy with culturally diverse populations. Counselor empathy contributes significantly to a counselor’s multicultural competence (Constantine, 2000). For example, Constantine (2002) found that both cognitive and affective empathy were significant predictors of perceived multicultural competence. Similarly, Constantine (2001a) reported that higher levels of actual multicul- tural competence are associated with higher levels of multicultural training and affective empathy. Relatedly, Fuertes and Brobst (2002) reported that client ratings of counselor multicultural competence have a high, positive correlation with empathy. The literature shows a clear connection between empathy and multicultural competence. Yet the literature concerning the cultural contexts of empathy with racially and ethnically diverse clients re- mains scarce (Miville, Carlozzi, Gushue, Schara, & Ueda, 2006). Relatedly, Johnson et al. (2002) found that when they compared criminal case vignettes that portrayed White defendants in one condition and Black defendants in another, White students exhibited greater levels of empathy for the cases with the White defendant. Results from their study indicated that the racial group membership of the defendant in the criminal case influenced the relationship between the race of the participant and the participant’s empathic response to the defendant in the case. Although re- search suggests that an individual’s race can influence a person’s empathic response to certain stimuli, a gap still remains in the counseling psychology field that specifically addresses counselor empathy with respect to cultur- ally diverse clients. In particular, to date, counselor empathy toward MEA clients has not been empirically investigated in the literature. The current study investigated if differences in empathy scores among vignettes were moderated by trainee race.

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multicultural cse Using Bandura’s (1986, 1997) social cognitive theory, Lent et al. (2006) defined CSE as trainees’ beliefs about their ability to perform behaviors spe- cifically with regard to their counseling roles. Recent literature has revealed a strong association between CSE and counselor multicultural competence (Constantine, 2001a). Constantine (2001a) found that trainees’ general CSE beliefs about their abilities to work efficiently with clients are related to their perceptions of their abilities to work with culturally diverse clientele. Hence, Constantine’s (2001a) findings supported the theory that counselors, both trainees and professionals, often see themselves as more or less effective with particular clients (e.g., culturally diverse clients), client types, or client issues (Lent et al., 2006). Ladany et al. (1997) found that trainees of color reported greater multi- cultural competence than White trainees when working with clients of color. Perhaps the greater multicultural competence of trainees of color is influenced by a greater sense of multicultural CSE in work with clients of color (Sheu & Lent, 2007). The CSE beliefs of counselors may drive them toward a specific area of expertise, client type, and/or clinical setting over time, which may allow them to focus on the clientele with whom they believe they do their best work. For example, trainees of color may have higher CSE when working with clients of color, perhaps because of the exposure that persons of color have to cross-cultural situations (Bandura, 1977). In light of the above research and drawing on Bandura’s (1986, 1997) social cognitive theory and the multicultural competence literature, Sheu and Lent (2007) defined multicultural CSE as the counselor’s self-efficacy regarding his or her perceived ability to provide individual therapy to clients who are racially different from the counselor. Sheu and Lent also developed a multicultural CSE scale to measure counselors’ beliefs about their ability to provide culturally competent counseling to racially diverse clients. Apart from Sheu and Lent’s (2007) study, which found that trainees of color reported higher perceived multicultural counseling competence than White trainees when working with ethnically and racially diverse clients, little current research has focused on counselor multicultural CSE with respect to clients who represent a specific ethnicity or race. In particular, in this study, we empirically measured the multicultural CSE of counselors with respect to working with MEA clients. Given that increased interaction with minority cli- ents and exposure to cross-cultural situations (Bandura, 1977) may contribute to higher rates of self-efficacy, another purpose of this study was to compare the multicultural CSE of White trainees with trainees of color with regard to counseling MEA clients. Specifically, using Sheu and Lent’s definition of multicultural CSE, we sought to determine if the differences in multicultural CSE between the vignettes would be moderated by trainee race.

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method procedure

After obtaining approval from Lehigh University’s institutional review board, we recruited participants through electronic contact with internship train- ing directors and program directors of master’s and doctoral programs in counseling psychology, clinical psychology, counselor education, social work, and marriage and family therapy. We also recruited people through professional contacts, various professional electronic mailing lists, and state psychological associations. A hyperlink to the online survey was embedded within an e-mail to a web-based Internet survey program (i.e., Psychdata) used to collect responses in a secure and confidential manner. The Psychdata program randomly assigned participants to one of a total of three possible vignettes. After participants read the vignette, they completed a series of online measures in the following order: (a) demographic questionnaire, (b) multicultural competence measure, (c) empathy measure, and (d) multicultural CSE measure. To ensure anonymity and confidentiality, we did not ask participants to identify themselves at any point. Participants had the option to withdraw from the study at any point without penalty. Participants with 5% or more missing data from any scale or subscale were removed from the data set (DiLalla & Dollinger, 2005).

participants

The gender of the participants (N = 256) was 82.8% female, 16.8% male, and 0.4% transgender. Participants’ ages ranged from 20 to 62 years, with a mean age of 30.2 years (SD = 7.75). The racial background of the participants was 68.4% White and 31.6% people of color. The breakdown of people of color was 7.4% Black/African American, 7.4% Hispanic/Latino, 4.7% multiracial, 4.7% Asian American/Pacific Islander, 0.8% Middle Eastern, 0.4% American Indian/Alaskan Native, and 6.2% other. Participants’ religious affiliations were 56.6% Christian, 10.2% agnostic, 7.8% atheist, 4.3% Jewish, 1.2% Muslim, 1.1% Hindu, and 18.8% other. The sexual orientation of the participants was 82.0% heterosexual, 7.0% bisexual, 5.5% lesbian, 3.5% gay, and 2.0% other. The 256 participants in this study represented the following training programs: master’s in counseling psychology (25.8%), doctorate (PhD) in clinical psychology (20.3%), doctorate (PhD) in counseling psychology (16.8%), doctorate (PsyD) in clinical psychology (14.5%), master’s in mar- riage and family therapy (9.0%), master’s in counselor education (3.5%), doctorate (PhD) in marriage and family therapy (3.5%), doctorate (PhD) in counselor education (3.5%), master’s in school counseling (1.6%), master’s in clinical psychology (1.2%), and other (0.3%). The breakdown by random stimulus assignment was the following: White trainees who received Vignette 1 (23.0%, n = 59), White trainees who received

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Vignette 2 (19.5%, n = 50), White trainees who received Vignette 3 (25.8%, n = 66), trainees of color who received Vignette 1 (9.0%, n = 23), trainees of color who received Vignette 2 (10.9%, n = 28), and trainees of color who received Vignette 3 (11.7%, n = 30); the percentages do not total 100 because of rounding. We used Erdfelder, Faul, and Buchner’s (1996) methods for power analysis for multivariate analysis of variance. An a priori power analy- sis indicated that a minimum sample size of 55 participants was necessary to have a statistical power of .80 to detect an interaction effect of vignette and trainee race, assuming a medium effect size of .15 and an alpha level of .05. This minimum sample size was met for this study, and the projected minimum cell size of 10 participants in each of the six groups that read one out of the three vignettes was exceeded.

Measures

Clinical case vignettes. We created three clinical case vignettes that varied the degree of MEA characteristics of the client. The written content of all three vignettes was the same, with one exception: The name of the client was changed from Sara in Vignette 1 and Vignette 2 to Fatima in Vignette 3. The rationale for the name change was based on Bertrand and Mullainathan’s (2004) research that explored racial discrimination in the labor market. Bertrand and Mullainathan found that résumés with European American–sounding names (e.g., Emily) elicited 50% more callbacks than African American–sounding names (e.g., Lakisha). Thus, the name of the client was changed in one of the vignettes to assess if the name change influenced the differences in the responses on the dependent variables between White trainees and trainees of color. All of the vignettes included a picture of the client presented in the case illustration. The picture in the vignettes was of the same person. In Vignette 1, the client was not wearing a full head covering. However, for Vignette 2 and Vignette 3, the client wore a full head covering in the picture. Thus, when comparing Vignette 1 and Vignette 2, we investigated if, while holding the name of the client constant but changing the images, there would be differences between the vignettes on the variables of multicultural competence, empathy, and mul- ticultural CSE moderated by trainee race. Similarly, when comparing Vignette 2 and Vignette 3, we investigated if, while holding the client’s picture constant and changing the name, there would be differences between the vignettes on the above-mentioned dependent variables moderated by trainee race.

Demographic questionnaire. The purpose of the demographic questionnaire was to gather information about each participant. In particular, the participants identified their age, gender, race, nationality, religion, sexual orientation, theoretical orientation, current training program, emphasis on multicultural training in their current program, number of multicultural courses taken, number of weeks of individual counseling, and total number of clients seen.

Cross-Cultural Counseling Inventory–Revised. The Cross-Cultural Counseling Inventory–Revised (CCCI-R; LaFromboise, Coleman, & Hernandez, 1991) is

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a 20-item measure whose items are scored on a 6-point Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree). A sample item is “A counselor values and respects cultural differences.” The CCCI-R is designed to measure counselors’ multicultural competence. The instructions of the measure were modified for the purpose of this study to be used as a self-report reflection tool for the trainees to report perceptions of their own multicultural com- petence as a clinician. All adjustments to the items were within the advised limits provided by the scale’s authors (LaFromboise et al., 1991). The CCCI- R is based on the APA Division 17 Education and Training Committee’s list of cross-cultural therapy competencies (Sue et al., 1982) and is designed to assess competence in three areas: cultural awareness and beliefs, cultural knowledge, and cross-cultural counseling skills. The content and construct validity of the CCCI-R were established via ratings provided by independent judges, who compared the items with the commit- tee’s expressed competencies and via factor analysis (Pomales, Claiborne, & LaFromboise, 1986). Internal consistency analysis of the rewritten form yielded an alpha of .90 in a study by Fuertes et al. (2006). The CCCI-R has been validated for use with participants from diverse racial and ethnic back- grounds with alphas of .97 (Inman, 2006) and .88 (Ladany et al., 1997). The Cronbach’s alpha for this sample was .84.

Interpersonal Reactivity Index. The Interpersonal Reactivity Index (IRI; Davis, 1980) is a 28-item measure whose items are scored on a 5-point Likert-type scale ranging from 1 (does not describe me well) to 5 (describes me very well). A sample item is “I often have tender, concerned feelings for people less fortu- nate than me.” The IRI assesses both cognitive and affective components of empathy with its four subscales: (a) Fantasy (measures participants’ tendencies to imaginatively take on the feelings and actions of made-up characters in plays, movies, and books), (b) Perspective Taking (the inclination to unex- pectedly adopt the psychological viewpoint of another person), (c) Empathic Concern (other-oriented feelings of concern and sympathy for those who are unfortunate), and (d) Personal Distress (self-oriented feelings of personal anxiety and discomfort in stressful interpersonal situations). Each subscale consists of seven items. Subscale scores are calculated by adding the item responses for each subscale. Davis (1980) reported the following alpha coefficients for the four subscales: .78 for men and .75 for women on the Fantasy subscale, .72 for men and .70 for women on the Empathic Concern subscale, .78 for men and .78 for women on the Personal Distress subscale, and .75 for men and .78 for women on the Perspective Taking subscale. The internal consistency alphas for the IRI ranged from .63 to .70 for Perspective Taking and from .66 to .77 for Empathic Concern (Constantine, 2000, 2001a; Miville et al., 2006). Only the Perspective Taking and the Empathic Concern subscales were used in the current study, with the Perspective Taking subscale measuring cognitive empathy and the Empathic Concern subscale measuring affective empathy. The Cronbach’s alphas for the Empathic Concern and Perspective Taking subscales for this study were

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.73 and .77, respectively. Although we used only two out of the four subscales in this study, to maintain the psychometric properties of the measure, we had participants complete the measure in its entirety. Miville et al. (2006) reported that the IRI provides the most reliable empathy scale available to date.

Multicultural Counseling Self-Efficacy Scale–Racial Diversity Form. The Multicultural Counseling Self-Efficacy Scale–Racial Diversity Form (MCSE-RD; Sheu & Lent, 2007) consists of three subscales: Multicultural Intervention, Multicultural Assessment, and Multicultural Session Management. The Multicultural Inter- vention subscale consists of 24 items, including perceived ability to remain flexible and accepting in resolving clients’ cross-cultural issues. The Multicul- tural Assessment subscale consists of six items, including the perceived ability to implement culturally appropriate assessment tools according to the client’s cultural background. The Multicultural Session Management subscale consists of seven items. The total scale consists of 37 items, and ratings are made on a 10-point scale ranging from 0 (no confidence) to 9 (complete confidence). Item responses are summed and divided by 37, creating one total scale score for multicultural CSE that can range between 0 and 9. In accordance with Lent et al. (2006), we revised the items to be specific to the case vignette. For example, the sample item that reads “assess culture bound syndromes for racially diverse clients” was changed to “assess culture bound syndromes for the client you just read about.” Internal consistency reliabilities for the MCSE-RD subscales of Multicultural Intervention, Multi- cultural Assessment, and Multicultural Session Management ranged from .92 to .98 (Sheu & Lent, 2007). The internal consistency for the MCSE-RD total score yielded an alpha of .98. The Cronbach’s alpha for this study was .97.

results preliMinary analyses

We conducted a series of multivariate analyses of variance (MANOVAs), specifying the four measures of interest in this study as the dependent vari- ables (i.e., multicultural competence, cognitive empathy, affective empathy, and multicultural CSE) and using each categorical demographic factor (i.e., participant gender, age group, race, religion, sexual orientation, type of train- ing program, theoretical orientation, counseling experience, multicultural courses taken, and trainee experience with multicultural trainings) as the independent variable to examine whether the participants’ demographic variables influenced the outcomes of this study. The alpha level was set to p < .001 to minimize Type I error and have a conservative estimate of any po- tential confounding effects. The MANOVA results all showed nonsignificant group differences, indicating that none of the demographic variables were likely to be confounding variables in this study. We then calculated correlations for the four dependent variables (i.e., multicultural competence, affective empathy, cognitive empathy, and multi-

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cultural CSE). The correlation matrix, means, and standard deviations for these four variables are presented in Table 1. Correlation analyses revealed small to moderate correlations between the dependent variables. Multicul- tural competence was significantly correlated with affective empathy (r = .15, p = .014), cognitive empathy (r = .28, p < .001), and multicultural CSE (r = .62, p < .001). Affective empathy was significantly correlated with cognitive empathy (r = .21, p = .001). Cognitive empathy was significantly correlated with multicultural CSE (r = .28, p < .001). Refer to Table 2 for participant mean scores and standard deviations on all four dependent variables for all six cells of the design.

data analyses

To examine differences between trainee race across three clinical case vignettes in terms of four dependent variables measuring competent counseling for MEA clients (i.e., multicultural competence, cognitive empathy, affective empathy, and multicultural CSE), we conducted a 2 (trainee race: trainee of color, White trainee) × 3 (vignette type: Vignette 1, Vignette 2, Vignette 3) factorial MANOVA. The multivariate test for the trainee race main effect found significant differences, Wilks’s λ = .92, F(4, 247) = 5.47, p < .001, par- tial η² = .08, between trainees of color and White trainees on two of the four dependent variables being analyzed. Effect size was calculated using partial η² (Gravetter & Wallnau, 2013). Follow-up univariate analyses of variance revealed that trainees of color (M = 102.78) had significantly higher multi- cultural competence scores, F(1, 250) = 14.31, p < .001, partial η² = .05, than White trainees (M = 98.87). In addition, trainees of color (M = 7.95) had significantly higher multicultural CSE scores, F(1, 250) = 9.15, p = .003, partial η² = .04, than White trainees (M = 7.50). Multivariate tests for the interaction effect of vignette and race were not statistically significant, Wilks’s λ = .99, F(8, 494) = 0.44, p = .899. These values are presented in Table 3. Although the interaction effect of vignette and race was not statistically significant, we conducted analyses to compare Vignette 1 with Vignette 2 to determine if, while holding the name of the client constant and changing

Table 1

Correlation Matrix for the Study Variables

Variable 1. Mc 2. ae 3. CE 4. MCSE

2 3 4 M SD .15*

— .21** .04

.28** .21**

— .28**

.62** .04 .28**

—

100.06 29.37 28.34 7.64

7.80 3.68 3.94 1.12

Note. N = 256. MC = multicultural competence; AE = affective empathy; CE = cognitive empathy; MCSE = multicultural counseling self-efficacy. *p < .05, two-tailed. **p < .01, two-tailed.

1 —

.15* .28** .62**

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the picture, the differences between White trainees and trainees of color on the variables of multicultural competence, empathy, and multicultural CSE were moderated by trainee race. Results of this contrast were not statistically significant, Wilks’s λ = .99, F(4, 247) = 0.42, p = .794. In addition, we conducted the planned linear contrast analysis to compare Vignette 2 with Vignette 3 to determine if, while holding the picture constant and changing the name of

Table 3

Multivariate and Univariate analyses of Variance for Dependent Variables

Source Race (R) Vignette (V) r × v

F F F F F 5.47***a

0.95 0.44

14.31***b

0.18 0.38

0.00 2.06 0.12

1.55 2.08 0.88

Note. MC = multicultural competence; AE = affective empathy; CE = cognitive empathy; MCSE = multicultural counseling self-efficacy. adf = (4, 247). bdf = (1, 250). *p < .05. ***p < .001.

Wilks’s l .92 .97 .99

Multivariate

Univariate

MC ae Ce MCSe

9.15*b

0.16 0.35

Table 2

Means and Standard Deviations for Dependent Variables by Cell

Dependent Variable Multicultural competence

Affective empathy

Cognitive empathy

Multicultural counseling self-efficacy

Vignette M SD 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3

98.92 99.32 98.36 103.61 101.96 102.77 29.70 29.88 28.65 29.35 30.00 28.87 28.66 28.94 28.21 29.00 27.93 26.90 7.44 7.53 7.48 7.99 7.82 7.76

1.00 1.08 0.94 1.60 1.45 1.40 0.48 0.52 0.45 0.77 0.69 0.67 0.51 0.56 0.48 0.82 0.74 0.72 0.14 0.15 0.13 0.22 0.20 0.20

Race White trainees

Trainees of color

White trainees

Trainees of color

White trainees

Trainees of color

White trainees

Trainees of color

Cell

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the client, the differences between White trainees and trainees of color on the variables of multicultural competence, empathy, and multicultural CSE were moderated by trainee race. Results of this contrast were not significant, Wilks’s λ = .99, F(4, 247) = 0.55, p = .698.

discussion The purpose of this study was to determine if trainees’ race moderated the differences in multicultural competence, empathy, and multicultural CSE when they worked with MEA clients. Three clinical case vignettes that presented a client with varying MEA characteristics were used to explore the differences between White trainees and trainees of color in counselor multicultural competence, empathy, and multicultural CSE for working with MEAs, who varied in terms of MEA characteristics. Results from this study suggest that differences in the dependent variables of multicultural competence, empathy, and multicultural CSE between the vignettes were not moderated by trainee race. Thus, it is important to discuss why this study did not reveal a significant interaction effect for trainee race and the vignette type. One factor to consider is that the differences between client descriptions from one vignette to another may have been too subtle, thus eliciting similar responses for measures of multicultural competence, empathy, and multicultural CSE. Perhaps, because all of the vignettes described the client as “Middle Eastern American,” they elicited similar responses to measures of the dependent variables. Another factor to consider with regard to the vignettes is that the client in the vignette had phenotypic characteristics that were very similar to European American characteristics (e.g., fair skin color, lighter facial features). Perhaps if another individual were in the picture (i.e., someone with darker features) or if the gender of the client were changed to represent an MEA man, the vignettes may have elicited different responses. Finally, another factor to consider is that perhaps participants’ racial or ethnic identity influenced their responses to the questionnaires. For example, one participant marked her race as “White” on the demographic questionnaire, but in the “other” section explained that she was adopted by a Black fam- ily when she was young and ethnically self-identified as Black. Research has documented a positive relationship between racial identity and multicultural competence, in which higher levels of racial identity have correlated with higher levels of multicultural counseling competency (Vinson & Neimeyer, 2003). One can logically assume that higher levels of racial identity suggests that an individual has an awareness and understanding of his or her own culture, which, in turn, can affect his or her sensitivity and understanding of the culture of others (Vinson & Neimeyer, 2003). Thus, the differences in multicultural competence, empathy, and multicultural CSE between the varying vignette types may have been moderated by trainee racial or ethnic identity.

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Although the study’s findings did not support the main research hypoth- esis, this study did reveal some noteworthy findings. Findings from this study are consistent with those of previous empirical literature that suggest that counselors of color score significantly higher than White counselors across a number of multicultural competence subscales that measure counselor awareness, knowledge, and skills with culturally diverse clients (Chao, 2006; Chao et al., 2011; Hill et al., 2013; Ponterotto et al., 1996; Pope-Davis & Ot- tavi, 1994; Vinson & Neimeyer, 2000, 2003). Furthermore, findings from this study are consistent with Sheu and Lent’s (2007) research that supports dif- ferences between White trainees and trainees of color on some dimensions of multicultural CSE. Perhaps the varied experiences in working with culturally diverse clients of both White trainees and trainees of color are related to their self-perceived multicultural counseling competencies and multicultural CSE. Although this study revealed some interesting findings, it is not without limitations. A threat to external validity is a concern because results are not generalizable for all trainees because of varying participant demographics. Furthermore, because the term Middle Eastern pertains to multiple countries, results may not be generalizable to one specific Middle Eastern country. Finally, the use of vignettes may be limiting in their abilities to represent a real, live client. Counselor multicultural competence, empathy, and multicultural CSE have been deemed as essential counselor characteristics for competent, effective psychotherapy across cultures (Constantine & Ladany, 2001; Sue & Sue, 2008). The current study enhances the understanding of how both trainees of color and White trainees respond to MEA clients in terms of overall multicultural competence, empathy, and multicultural CSE. Findings from this study also suggest further exploration of additional variables, such as racial identity, which may influence multicultural competence, empathy, and multicultural CSE. The current study supports Constantine and Ladany’s (2001) theory of mul- ticultural competence by investigating the multicultural competence of both White trainees and trainees of color. Because theory suggests that counselor multicultural awareness is measured by assessing counselor knowledge, aware- ness, and skills (Constantine & Ladany, 2001; Sue & Sue, 2008), the current study provides further empirical evidence that these areas do actually con- stitute multicultural awareness in both White trainees and trainees of color. Empathy is another counselor variable that is important to consider when working with diverse clientele such as MEAs. Theoretically, cultural empathy (Ridley & Lingle, 1996; Trimble, 2010) and ethnocultural empathy (Wang et al., 2003) have been used in the counseling psychology literature to provide a better understanding of the role of empathy in counseling diverse cultural groups. Findings from this study suggest that White trainees and trainees of color do not differ in their levels of empathy toward MEA clients. Perhaps categoriz- ing trainees solely on the basis of their racial demographics is limiting and not inclusive of other trainee variables that may influence empathy, such as racial

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or ethnic identity and exposure to or experience working with MEA clients. The current study expands both the empirical literature on multicultural competence, empathy, and multicultural CSE and the scant literature on MEAs. This study revealed significant differences between White trainees and trainees of color on the variables of multicultural competence and multicultural CSE, but not on empathy. These findings warrant future in- vestigation to see why there are differences between trainees of color and White trainees on some measures that are essential for working with diverse client populations (e.g., multicultural competence and multicultural CSE) and not others (e.g., empathy). Perhaps other counselor variables, such as differing levels of trainee racial/ethnic identity, are contributing to these group differences on some variables and not others. Chao et al. (2011) found that multicultural training can moderate the relationship between trainee race and multicultural awareness; thus, trainee level and years of multicultural training are other potential variables that may be contributing to differences between White trainees and trainees of color on multicultural competence, empathy, and multicultural CSE with MEA clients. Future inves- tigations should explore the role of trainee racial/ethnic identity as well as trainee level of multicultural training in relation to counselor multicultural competence with MEAs.

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