Diversity and Cultures

TRAINEE MULTICULTURAL CASE CONCEPTUALIZATION ABILITY AND COUPLES THERAPY

Allison M. Schomburg University of Akron

Loreto R. Prieto Iowa State University

Previous literature on the assessment of multicultural counseling competence has been concerned only with counselors’ abilities when working with individual clients. We expanded this line of research by investigating trainees’ multicultural case conceptualiza- tion ability in the context of working with couples. Despite the fact that trainees self- reported a high level of multicultural competency, trainees were largely inattentive to racial factors in their case conceptualization responses to vignettes involving both African American and European American clients presenting for couples therapy. On the whole, despite didactic, clinical, and extracurricular training in multiculturalism, marriage and family therapy trainees did not sufficiently incorporate cultural factors into their clinical case conceptualizations. We discuss implications for teaching, practice, and future research.

In the last decade, investigators and educators in marriage and family therapy (MFT) have paid an increased level of attention to multicultural issues. Guidelines for working with diverse families have been produced (Bean, Perry, & Bedell, 2001, 2002), educators have emphasized cultural diversity in the recruitment of students and in curricula (Hardy & Keller, 1991; Sierra, 1997), and MFT researchers have modestly increased diversity-related scholarship (Killian & Hardy, 1998).

However, some observers have noted a continuing lack of minority representation in MFT programs, a lack of primary research interests in multiculturalism among MFT scholars, and a lack of multicultural competency evaluations of trainees as deficits remaining within MFT pro- grams (cf. Inman, 2006). In response to these deficits, some authors have created multicultural training guidelines (cf. Green, 1998). However, the usefulness and validity of proposed models and methods to assess trainee multicultural competencies have been called into question.

In particular, several scholars (e.g., Atkinson & Israel, 2003; Constantine & Ladany, 2001; Vera & Speight, 2003; Weinrach & Thomas, 2002) have criticized the theoretical and practical limitations of the most popular model for assessing multicultural competencies, the Sue and Sue (1999) rubric of multicultural knowledge, skill, and awareness. As well, the self-report instruments used to assess these multicultural competencies have been demonstrated to have poor psychometric qualities (Constantine & Ladany, 2001; D’Andrea, Daniels, & Heck, 1991; Ponterotto, Rieger, Barrett, & Sparks, 1994; Pope-Davis & Dings, 1994, 1995).

Investigators have also argued that socially desirable responding may contaminate the responses on self-report measures of multicultural counseling competence (Constantine &

This manuscript represents a portion of a dissertation completed by Schomburg, under the direction of

Prieto, as a part of the requirements for her doctoral degree at the University of Akron. Allison M. Schomburg

is now a Staff Psychologist at the Creighton University Counseling and Psychological Service, Creighton

University; Loreto R. Prieto is a Professor of Psychology and Director of U.S. Latino ⁄ a Studies at Iowa State University.

We would like to thank Ms. Abby Bjornsen, MA, University of Nebraska-Lincoln, and Ms. Sara

Streedbeck, Southeast Community College, for their assistance with coding data in this study.

Address correspondence to Loreto R. Prieto, PhD, Department of Psychology, Iowa State University, Ames,

Iowa 50011-3180; E-mail: [email protected]

Journal of Marital and Family Therapy doi: 10.1111/j.1752-0606.2009.00156.x April 2011, Vol. 37, No. 2, 223–235

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Ladany, 2001). As well, the myriad of instruments designed to measure multicultural compe- tence domains appear to not be measuring similar constructs. Pope-Davis and Dings found that the Awareness subscales of the Multicultural Counseling Inventory (MCI; Sodowsky, Taffe, Gutkin, & Wise, 1994) and the Multicultural Counseling Knowledge and Awareness Scale (MCKAS; Ponterotto, Reiger, Gretchen, Utsey, & Austin, 1999) shared only 10% of their variance. Similarly, Worthington, Mobley, Franks, and Andreas Tan (2000) found the MCI (Sodowsky, et al., 1994) and the Cross-Cultural Counseling Inventory-Revised (CCCI-R; LaFromboise, Coleman, & Hernandez, 1991) to have negative or near zero correlations. These measures have also been uniformly used to assess competence only in individual counseling interactions rather than in interactions with larger client systems as carried out in couple and family therapy (Constantine & Ladany, 2001). Finally, traditional self-report, multicultural competency inventories are likely to measure anticipated rather than actual multicultural coun- seling competence. In other words, these instruments are tapping trainees’ sense of self-efficacy in the future execution of the competencies (Constantine & Ladany, 2000; Pope-Davis & Dings, 1995). Statistically speaking, little relation appears to exist between how trainees view their own sense of multicultural competency and the behaviors they actually demonstrate.

Multicultural Case Conceptualization Ability Because of the shortcomings of traditional methods used to assess multicultural compe-

tency, Constantine and Ladany (2001) developed a behavior-based method of assessment that objectively evaluates trainees’ case conceptualization ability in terms of the incorporation of cli- ents’ cultural variables. Studies using this method have assessed to what degree respondents actually integrate and differentiate multicultural information into the etiology and treatment conceptualizations associated with clients’ presenting concerns (Constantine & Ladany, 2000, 2001; Ladany, Inman, Constantine, and Hofheinz, 1997).

Only one study to date has used the multicultural case conceptualization ability (MCCA) task with a marriage and family focus. Inman (2006) sampled 147 MFT trainees to determine their perceptions of supervisor multicultural competence and their satisfaction with supervision. In part, Inman found a lack of a significant correlation between trainee self-reported and MCCA-based multicultural counseling competence. Interestingly, despite using an MFT trainee sample, the MCCA vignette used by Inman in this study depicted an individual client seeking individual counseling.

Criticisms of the MCCA Method Despite being an advance from previous assessment tools, limitations have been found with

the MCCA method. Bromley (2004) reported that vignettes used in previous MCCA research described a single client who is seeking individual counseling services. In addition, all but one of these six vignettes described only a client of color. All failed to assess whether counselors account for the impact of race for European American clients. Current developments in the domain of multicultural psychology (e.g., White privilege, White racial identity development, color-blind racial attitudes) suggest that trainees also need to appreciate racial factors when working with majority culture clients.

In addition, there is a lack of consensual validation both among traditional self-report mea- sures of multicultural competency as well as between observed and self-reported multicultural competency measures (Constantine & Ladany, 2000; Ladany et al., 1997). This has led to two main questions: Which method is the more ‘‘accurate’’ and ‘‘valid’’ measure of trainees’ compe- tency (e.g., self-report instruments or the MCCA behavioral task), and Why do these two methods of assessing multicultural competency (e.g., self-report instruments or the MCCA behavioral task) have little to no correlation with one another? Finally, past MCCA research has not provided verbatim examples of participants’ written responses so that educators and supervi- sors might have a qualitative sense of what a stronger versus weaker MCCA looks like.

Bromley (2004) advanced the typical use of the MCCA method in previous research by providing two conditions for the race of the client in stimulus vignettes (European American and African American) and using a multidimensional approach to examine the influence of social desirability on MCCA scores. Bromley’s results indicated that trainees tended to ignore

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cultural ⁄ racial variables in the European American client vignette but did attend to these vari- ables in the African American vignette condition. Unexpectedly, multidimensional aspects of socially desirable responding were not related to self-reported multicultural counseling compe- tence or MCCA task scores. Bromley also failed to find a statistically significant correlation between scores trainees obtained on the MCCA task and trainees’ self-reported level of multi- cultural counseling competency. Bromley’s recommendations were that researchers use vignettes containing clients from both majority and minority groups and continue to further clarify the relation between the MCCA and self-reported competency measures.

Purpose and Research Questions The purpose of our study was to advance the scarce research in MFT examining the assess-

ment of multicultural counseling competence in marriage and family trainees, particularly their ability to conceptualize clients from a multicultural perspective. To increase validity over past research, we used an MCCA stimulus vignette that described a couple presenting for treatment rather than an individual presenting for individual counseling. In addition, we utilized vignette conditions with both European and African American couples. As in previous research, we examined the relation between our MCCA task and a self-report measure of multicultural counseling competence (cf. Bromley, 2004). Finally, we examined which method of assessing multicultural counseling competence (MCCA or self-report) was most related to variables that are theoretically expected and empirically shown to contribute to multicultural counseling competence (e.g., course work, clinical experience with racially diverse clients, time spent in supervision discussing multicultural issues).

Our hypotheses for this study were that (a) social desirability will be statistically signifi- cantly positively correlated with both the Knowledge and Awareness subscales of the MCKAS; (b) social desirability will not be statistically significantly positively correlated with trainees’ MCCA scores; (c) the MCKAS will not be statistically significantly correlated with MCCA etiology or treatment scores; (d) main effects for the MCCA vignette race condition will exist, with participants generating statistically significantly higher mean scores on the African American vignette versus European American clients; and (e) multicultural training and clinical experience variables will account for greater variance in MCCA scores when compared with MCKAS scores.

METHOD

Participants This study received the approval of an Institutional Review Board, and all human subjects’

rights were observed. We sampled trainees from both MFT and counseling psychology (CP) pro- grams. The inclusion of CP trainees was carried out for two reasons. First, both training directors and students in American Psychological Association-accredited (APA) CP programs had noted CP students’ extremely high interest in learning about and conducting marital and family counsel- ing (Fitzgerald & Osipow, 1988; Schneider, Watkins, & Gelso, 1988). Second, approximately one- quarter of all APA-accredited CP programs offer some type of training in MFT, ranging from course work all the way through specialty practicum training in marriage and family therapy (Council of Counseling Psychology Training Programs listserv communication, 2007).

The names and email addresses of training directors were obtained from the American Association for Marriage and Family Therapy (AAMFT) and Council of Counseling Psycho- logy Training Programs (CCPTP) websites (http://www.aamft.org and http://www.ccptp.org, respectively; available). A total of 113 MFT and CP trainees from across the United States and Canada responded to our survey. These trainees reported to be a mean age of 31.2 years (SD = 8.6; range 22–72 years). There were 88 women (78%) and 25 men (22%). Participants reported the following racial ⁄ ethnic identification: European American (69%), African American (6%), Asian American (6%), Hispanic ⁄ Latino (3%), International (6%), multiracial (4%), and other (6%). Twenty-three participants were enrolled in a master’s program, 86 in doctoral programs, and 4 in ‘‘other’’ programs. Participants were reported to have a mean of 7.6 semesters of graduate study (SD = 4.3).

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Procedures Training directors passed on to students our email soliciting participation in the study.

Potential respondents read an introduction to the study and the informed consent statement, and they were provided a link to the survey web page. The interactive online system at SurveyMonkey.com was used to collect data. All data were kept confidential and were reported in aggregate form so that neither individual participants nor institutions could be identified. Participants were randomly assigned to the African American or European American vignette condition. As an incentive to participate, respondents were entered into a drawing for two $50 gift certificates to a national bookstore chain.

Research materials included a demographic questionnaire, an MCCA clinical vignette, the MCKAS, and the Balanced Inventory of Desirable Responding. The vignette was presented first to protect responses from being influenced by the ensuing questionnaires (cf. Constantine & Ladany, 2000), followed by the BIDR, the MCKAS, and finally, the demographic questionnaire.

Measures Demographic questionnaire. This solicited information on trainee demography and educa-

tion and training experiences (e.g., semesters of graduate study; number of multicultural courses and marriage and family therapy courses taken).

Multicultural case conceptualization ability. Multicultural case conceptualization ability was operationalized in terms of how well participants recognized and integrated cultural factors into etiological and treatment conceptualizations of the vignette clients’ presenting problems. The vignette for this study was similar to those used in previous studies of MCCA (Bromley, 2004; Constantine & Ladany, 2001; Ladany et al., 1997) as well as general marriage and family therapy clinical vignettes (Boyd-Franklin & Franklin, 1998; Snyder, Cozzi, Grich, and Leub- bert, 2001). The vignette clients were a married, heterosexual couple, presented for couples counseling for problems with ‘‘communication’’—one of the most common presenting concerns of couples in therapy (Doss, Simpson, & Christensen, 2004).

In completing the MCCA, all participants were instructed to ‘‘read the following vignette and write a conceptualization of the etiology of this couple’s presenting concern and of your approach to treatment with this couple.’’ The text of the vignette for the African American race condition read as follows: ‘‘Tanya, 24, and Mike, 25, are an African American (Black) couple who have been married for 2 years. Tanya works as a loan officer and Mike is a graphic designer. They are both from a moderately sized urban city where they have gone to school (including college) and lived their whole lives. Both have recently accepted new jobs that neces- sitated their move to a new location in a major metropolitan city. The couple bought a house in a racially diverse neighborhood, a change from their previous neighborhood. They miss their old friends and have struggled to develop relationships with their new neighbors. The purchase of their house has also placed a financial strain on them, leaving little room for unplanned expenses.

‘‘They presented to counseling with what they described as ‘communication problems.’ Typically, they argued intensely over an issue, became angry and withdrew emotionally and physically from each other, and remain separated from each other for hours or sometimes days. These reoccurring conflicts were happening more often and increased in intensity over the past few months. They reported less satisfaction in their marriage and perceived receiv- ing less support from each other. They identified several concerns in their relationship, including increasing work stress, their lack of a social network for fun and recreation, and anxieties over finances.’’ All participants read this same vignette, with only the race of the clients altered across experimental conditions (either African American or European American).

MCCA scoring. The scoring system for MCCA responses has been used in numerous stud- ies (Constantine, 2001a, 2001b; Constantine & Gushue, 2003; Constantine & Ladany, 2000; Gainor & Constantine, 2002; Inman, 2006; Ladany et al., 1997). Participants’ written conceptu- alization responses to the vignettes were scored as follows: 0 = no indication of race or cul- tural factors in the conceptualization; 1 = one mention of race or culture with no integration; 2 = one mention of race or culture with some integration or two mentions of race with no

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integration; 3 = two or more mentions of race or culture with one integration; 4 = two or more mentions of race or culture with two integrations; and 5 = three or more mentions of race or culture with three or more integrations. Lower scores meant less frequent and less complex thinking about racial factors in conceptualizations; conversely, higher scores showed more frequent and complex thinking about racial factors in conceptualizations.

Two coders were trained to score the MCCA responses. Coders were unaware of the research hypotheses and independently rated the etiology and treatment responses. We provided coders with copies of the above-mentioned MCCA scoring scheme used by Ladany et al. (1997). Following training, the coders were given 14 MCCA responses to score (7 from the European American condition and 7 from the African American condition). The data from these 14 responses were used to calculate interrater reliability using Cohen’s Kappa (Cohen, 1960), a statistical procedure that controlled for chance agreement. The Kappa coefficient for etiology was 1.00 and for treatment was .85. These coefficients were high enough to ensure high interrater reliability in scoring MCCA responses.

Multicultural Counseling Knowledge and Awareness Scale. The MCKAS (Ponterotto, Gret- chen, Utsey, Rieger, & Austin, 2002) is a revision of the Multicultural Counseling Awareness Scale (Ponterotto et al., 1996). The MCKAS is a self-report, 32-item instrument using a 7-point Likert scale (1 = not at all true, 7 = totally true). Higher scores suggest higher self-reported multicultural counseling competence. The MCKAS is made up of two subscales: Knowledge (20 items) and Awareness (12 items). The Knowledge subscale measures general knowledge of multicultural counseling, and the Awareness subscale measures counselors’ attitudes and beliefs about working with culturally diverse clients. In validity studies, Ponterotto et al. (2002) reported internal consistency estimates for both subscales at .85, with the two subscales possess- ing a very small correlation of r = .04. Convergent validity evidence for the Knowledge subscale has been established through significant correlations with the Knowledge subscale of the MCI (Sodowsky et al., 1994). Criterion-related evidence for the Knowledge subscale is sug- gested by a significant correlation in the expected direction with ethnic identity development (Ponterotto et al., 2002).

Balanced Inventory of Desirable Responding. The BIDR (Paulhus, 1988, 1991) is a 40-item measure using a 7-point Likert scale ranging from 1 = not true to 7 = very true. Each subscale was made up of 20 items, leading to total scores on the self-deceptive enhancement (SDE) and impression management (IM) subscales that ranged from 0 to 20. The BIDR reflected two dimensions of socially desirable responding: SDE and IM. High scores on self-deceptive enhancement indicated that respondents believed in their overly positive self-reports. High scores on IM indicated that respondents consciously presented themselves in a favorable light. With respect to reliability, the BIDR demonstrated adequate internal consistency coefficients; for the SDE coefficients ranged from .68 to .80, and for the IM scale from .75 to .86. Test-retest correlations across a 5-week time period were .65 for the IM scale and .69 for the SDE scale. Concurrent validity was established by observing a .71 correlation of the BIDR with the Marlowe-Crowne Social Desirability Scale (Crowne & Marlowe, 1960) and a .80 correlation of the BIDR with the Multidimensional Social Desirability Inventory (Jacobson, Kellogg, Cauce, & Slavin, 1977). Self-deception and IM also form discrete factors in factor analyses (Paulhus 1984, 1988).

RESULTS

Preliminary analyses indicated that there were no significant differences in MCCA or MCKAS scores by trainee sex or race. As well, no differences were observed between MFT and CP trainees. Therefore, data from all participants were pooled for subsequent analyses of interest.

Measures MCCA. Fifty-seven participants completed the African American client vignette and 56

completed the European American vignette. Participants responding to the African American vignette scored a mean of .25 (SD = .83; Range: 0–4) for etiology and .35 (SD = .86; Range:

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0–4) for treatment. Participants responding to the European American vignette scored a mean of .23 (SD = .66; Range: 0–3) for etiology and .25 (SD = .72; Range: 0–3) for treatment. Qualitative examples of participants’ responses to the vignettes are in Table 1 to illustrate responses written in both vignette conditions that yielded lower and higher scores. Overall, trainees’ scores on the MCCA task were low, both in comparison with the scoring range possible (1–5) and when compared with those MCCA scores obtained in previous studies (cf. Bromley, 2004).

MCKAS. Internal consistency estimates for the MCKAS subscales were .87 for Knowl- edge and .75 for Awareness. The correlation between the two subscales was low at .23, suggest- ing that the scales appear to be independent and measuring different constructs. Sample M and SD for the MCKAS Knowledge and Awareness scales were M = 5.22, SD = .77 and M = 6.09, SD = .59, respectively. Knowledge and Awareness scores ranged from 3 to 7 and 4 to 7, respectively, for the sample.

BIDR. Internal consistency coefficients for the subscales of the BIDR were .70 for SDE and .80 for IM, comparable with estimates obtained during the development of the scale (see Paulhus, 1991). The correlation between the two subscales was .38; the scales shared a slight amount of variance but were clearly measuring distinct concepts. Sample M and SD for the BIDR SDE and IM scales were M = 5.30, SD = 3.21 and M = 6.68, SD = 4.05, respec- tively. SDE and IM scores ranged from 0 to 16 and 0 to 15, respectively.

Descriptive Findings Multicultural training. Participants reported having taken an average of 1.48 (SD = 1.21)

diversity courses and spent an additional average of 37.05 (SD = 60.47) hours attending diver- sity workshops, presentations, and training in graduate school. Participants reported providing an average of 202.59 (SD = 388.15) hours of counseling to racially ⁄ ethnically diverse clients, and received an average of 36.49 (SD = 66.93) hours of supervision devoted to discussing mul- ticultural issues. Asked to rate on a 7-point Likert scale (1 = Not at all to 7 = Totally) the extent to which they felt multicultural issues were infused in the overall curriculum and coursework of their training program, participants reported a mean of 5.02 (SD = 1.41), sug- gesting a good amount of infusion.

Marriage and family therapy training. Participants reported having an average of 3.32 (SD = 4.37) couples and ⁄ or family therapy courses. They also reported spending an additional average of 48.41 (SD = 76.38) hours attending couples and ⁄ or family therapy workshops, presentations, and trainings during graduate school. Participants reported providing a mean of 251.04 (SD = 469.71) hours of counseling to couples and families.

Correlational analyses. Intercorrelations among the MCCA treatment and etiology ratings, BIDR subscales, and MCKAS subscales indicated that socially desirable responding was not related to either trainees’ self-reported multicultural counseling competencies or their ability to account for cultural factors in case conceptualizations. The Awareness subscale of the MCKAS was statistically significantly (but weakly) related to MCCA etiology (r = .20; p < .05) and treatment (r = .21; p < .05) scores, indicating that trainees who had more awareness of their attitudes and values toward racially different persons were more likely to incorporate racial factors into their conceptualizations of clients.

MCCA Analyses Using a multivariate analysis of covariance, we examined differences in trainees’ observed

ability to include race-based information in case conceptualizations as a function of the race of the client in the stimulus vignette. The independent variable was the race of the clients in the vignette (i.e., African American or European American). The dependent variables were the MCCA scores for etiology and treatment. The covariates were the two subscales of the BIDR, self-deceptive enhancement and IM.

Neither the covariate of the SDE subscale (Wilks’ Lambda [2, 108] = 1.29; p = .28) nor the IM subscale (Wilks’ Lambda [2, 108] = .18; p = .83) accounted for a significant amount of variance in MCCA scores. The dependent variables of MCCA scores were not significantly affected by the race of the clients in the vignette (Wilks’ Lambda [2, 108] = .30; p = .74).

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Table 1 Qualitative Exemplars of Lower- and Higher-Scoring Participant Responses to MCCA Vignettes

African American vignette Lower scoring

MCCA etiology score 0 MCCA treatment score 0 I would say they could be diagnosed with adjustment disorder. They have lost several major supports for their relationship by moving to the new community, starting new jobs, and increasing their financial commitments. They need to increase their intimacy and support for one another. I would try to help them increase their friendship and time spent together based on Gottman’s research or use EFT to increase their intimacy and overcome their pattern of attack-withdrawal.

African American vignette Higher scoring

MCCA etiology score 0 MCCA treatment score 4 The frame I use for conceptualization comes from a biopsychosocial model. From a biological perspective, I would determine whether Tanya or Mike had experienced past psychological difficulties or if they have a family history of psychological concerns. This would provide potential evidence toward a biological basis for psychological concerns. After ruling out any biological influence, I would focus more specifically on psychological and social influences on their relationship concerns. From a psychological perspective, I would assess their pattern of interaction throughout the relationship, pointing out consistent patterns as well as changes that seem to have occurred. From a social perspective, I would determine how much the recent environmental changes (work stress, lack of social network, and financial concerns) have affected both the psychological state for each individual as well as the interaction within their relationship. My approach to treatment would come from a culture-sensitive and interpersonal approach to therapy. I would discuss the cultural differences that may exist between myself and this couple, and make this an available aspect of the discussion between us. I would also explore the cultural implications of moving from their original neighborhood to a more racially diverse neighborhood. From an interpersonal perspective, I would try to highlight changes that have occurred in their relationship, and try to determine the influences that have caused these changes. I would emphasize communication and highlight the level of communication between this couple in the here and now of therapy. My overall goal would be to increase communication between the couple. As communication increases, I would also focus on strategies for the couple to reduce stress and ways to find a social network within their new community.

European American vignette Lower scoring

MCCA etiology score 0 MCCA treatment score 0 It’s difficult to say without an understanding of the specifics of the arguments (i.e., who initiates, who withdraws, whether there’s a recurring issue that’s argued, etc.). Generally, I believe couples become engaged in increasingly rigid negative interaction cycles due to unmet emotional needs and a desire to protect oneself from perceived threats to one’s sense of security. My approach to treating this couple, therefore, would include an attempt to

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Next, we conducted two regression analyses to determine which of the methods of assessing multicultural competency (an objectively scored ability task or a self-report measure) best accounted for the influence of variables known from previous theory and research to affect trainee multicultural competency. Independent variables included number of multicultural courses, clock hours of multicultural workshops, clock hours of counseling with racially ⁄ ethnically diverse clients in practicum, and clock hours of supervision devoted to multicultural issues.

Dependent variables in the regressions were MCCA scores (etiology and treatment). The BIDR subscales were entered as a first block of variables to control for elements of socially desirable responding. Number of clock hours of extracurricular diversity workshops, presenta- tions, training, or reading accounted for approximately 6% of the variance in MCCA treatment scores, after controlling for socially desirable response. When those same training and experi- ence variables were regressed against MCKAS scores, the number of multicultural courses taken and more hours spent in extracurricular multicultural training accounted for approxi- mately 16% of the variance in MCKAS Knowledge scores, after controlling for socially desir- able responding.

Finally, we provide exemplars of high- and low-scoring vignettes for each of the vignette conditions in Table 1. As could be seen from the exemplars and the extremely low average on MCCA scores for the overall sample, trainees neither recognized well that cultural issues played

Table 1 Continued

determine the couple’s interaction style, discover the unmet emotional needs, how those needs are being communicated ⁄ expressed, and help to create a new pattern of interaction in which each person feels safe to directly ask for those needs to be met.

European American Vignette Higher scoring

MCCA etiology score 3 MCCA treatment score 2 Tanya and Mike came to counseling after a change in work and geographical location. These changes included moving to a larger city, a more racially diverse location, and increased financial stress related to the purchase of their new home. If I were seeing one person from this couple, the recent stressor and attendant anxiety, quarreling, withdrawal, and conflicts would indicate the presence of an adjustment disorder with mixed anxiety and depressed mood (309.28). However, from a systems perspective, my view changes a bit. Certainly, the new situations present stressors for this couple, including grief for their former home and friends, a necessary adjustment to a different racial environment, and reduced emotional support related to having fewer friends and family immediately available. However, instead of their reactions diminishing over time as is usual with an adjustment disorder, they have been increasing. Because this relates to changes associated with normal developmental changes in life, in this case orienting to careers, there are aspects of a phase of life problem (V62.89). However, I am primarily concerned about their patterns of cohesiveness and communication within their family. In this time of increased stress and developmental changes, this couple has withdrawn from each other, become more conflictual, and become more isolated vis-á-vis the larger systems in their lives. I believe a systems approach with emphasis on how they are interacting with each other and improving their patterns of communication between the marital dyad will provide additional support and emotional resources for this couple. In turn, that will allow them to approach work, living in a racially diverse neighborhood, and financial stresses in a different manner, leading to a reduction in conflict, anxiety, and depressive symptomology (e.g., anger and fighting).

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a part in the treatment of clients’ difficulties, nor do they account well for how culture may have contributed to the emergence of the clients’ difficulties in the first place.

DISCUSSION

The purpose of our study was to build upon previous research investigating the assessment of multicultural counseling competence in MFT trainees using a multicultural case conceptuali- zation task method (Bromley, 2004; Constantine, 2001a, 2001b; Constantine & Gushue, 2003; Constantine & Ladany, 2000; Inman, 2006; Ladany et al., 1997). In the following sections, we will discuss, each in turn, the findings associated with our earlier stated hypotheses.

Social Desirability Effects Our findings revealed that the two assessed dimensions of social desirability did not to any

great extent correlate with the multicultural counseling competence measures (either self-report or behavior based). Thus, our first hypothesis was not supported, but the second one was; we expected a self-report measure of competency to be more vulnerable to socially desirable respond- ing. This was not the case. Some scholars suggest that mental health trainees may too easily see the demand characteristics to provide lower ratings when completing typical social desirability instruments used in psychological research (e.g., Constantine & Ladany, 2000), so there may not be enough variability in social desirability scores to effectively tease out a relation with other variables of interest. However, in our study, although a positive skew was present and the large percentage of social desirability scores was in the lower half of the score range, the full range of scores went across almost the full spectrum (0–16 with a ceiling of 20) for each of the domains examined (self-deception and IM). Thus, it may be that mental health trainees do not respond in strongly socially desirable ways (unlikely) or that social desirability instruments are not tapping the construct in such a way that the expression of social desirability by mental health trainees is detected by items intended more for research participants from the general public.

Relation Between MCCA and MCKAS Our third hypothesis that no relation would exist among the subscales of the MCKAS and

MCCA etiology and treatment scores was partially supported. That is, statistically significant (but very low magnitude) correlations among the MCKAS subscale of Awareness and the etiol- ogy and treatment scores of the MCCA did exist. When small magnitude correlations possessed statistical significance, this is most likely to suggest that the power of the test afforded by the sample size is what brought about the statistically significant finding. Primarily, this low- magnitude relation suggested that very little variance was shared between the two measures. The MCKAS and behavior-based MCCA are likely to measure different constructs concerning multicultural competence.

Race of Client in Vignettes Our study revealed no support for our fourth hypothesis that the race of the clients in the

vignette would differentially affect trainees’ incorporation of race-based information in case conceptualizations. In fact, MFT trainees were equally inattentive to racial factors when consid- ering either African American or European American clients. As diversity training has histori- cally focused on racial ⁄ ethnic minorities while overlooking racial issues for the majority group, such a lack of attention to European Americans may explain the lower MCCA scores in that condition. However, the sample also performed very poorly on the MCCA task in the African American condition. These two findings together suggested that trainees were consistently not taking racial factors into account in their conceptualizations of the vignette couples, environ- mental contexts, or their presenting problems.

Measuring Multicultural Counseling Competence: MCCA vs. MCKAS Trainees generally endorsed higher levels of multicultural counseling competence on the

MCKAS. Trainees who endorsed higher levels of Awareness on the MCKAS were also slightly more likely to incorporate racial factors into MCCA case conceptualizations. However, higher

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endorsement of multicultural Knowledge on the MCKAS was not associated with higher scores on the MCCA. The essential lack of meaningful correlation between the MCCA and MCKAS may be due to self-report measures like the MCKAS tapping trainees’ multicultural counseling self-efficacy beliefs (Constantine & Ladany, 2001), whereas the MCCA task is measuring an aspect of genuine behavioral competence. Prior research on self-efficacy and behavior had revealed only a moderate relationship between self-efficacy and objective measures of ability (Lent, Brown, & Larkin, 1986).

With respect to the primacy of one measurement method over the other, based on our find- ings, one measure did not strongly outperform the other, and neither performed well overall in terms of accounting for variance in training experiences known from previous research to affect multicultural counseling competency. Upwards of 84% of variance in diversity-related didactic and clinical training variables went unexplained by these methods of assessing multicultural competency. This did not reflect favorably on either the construct validity of these measures or their utility in assessing trainee growth in this critical area.

Elements associated with didactic training did account for more variance in both of the competency measures than did clinical experience. Previous studies have found a positive rela- tion between didactic training and multicultural counseling competence (Constantine, 2001a, 2001b; Constantine & Gushue, 2003). These findings suggest that clinical experience with diverse persons does not necessarily translate into greater multicultural counseling competency, although the reasons for this are unclear. Perhaps trainees feel more comfortable with didactic- based learning and may not yet know how to translate and integrate their clinical experiences into a ‘‘factual’’ knowledge base that informs their clinical work.

Recommendations for MFT Education and Training What are we doing right? Our findings suggest that didactic training is correlated with

enhancing trainees’ knowledge of cultural issues, and that the average trainee reports having received a good amount of didactic training, including at least one course and more than 70 additional clock hours of training concerning diversity issues. Higher levels of trainee awareness surrounding their attitudes and values concerning racially diverse persons were slightly correlated with increased cognitive complexity concerning the inclusion of racial issues in conceptualizations of client difficulties. Finally, trainees also reported a good level of program- matic infusion of diversity issues into their curricula.

These results help to support current efforts by training programs to increase their atten- tion to diversity issues. Although where the line of diminishing returns lies with respect to how much training is enough to obtain maximum educational benefit, it appears reasonable to assert that recent increases in emphasizing diversity training in MFT have been helpful. Moreover, no ceiling effect from the current level of training appears to have been reached, at least in terms of trainees reporting or demonstrating a fulfillment of their sense of multicultural competency. Thus, didactic activities that both help trainees learn factual knowledge about culturally sensi- tive MFT treatment as well as examine their own biases and attitudes toward working with racially diverse clients will likely continue to yield benefits to trainees.

Where can we improve? Our most startling findings are those that suggest that even with the noted increase in attention to diversity issues, MFT trainees are still woefully lacking in their ability to consistently demonstrate an inclusion of race in case conceptualizations regard- less of their levels of training and clinical experience. In addition, our findings suggest that nei- ther self-report measures nor behavioral tasks like the MCCA are sufficient measures to validly assess trainees’ level of multicultural competency. Clearly, neither current educational approaches nor assessment methods in diversity training have fully identified and capitalized on the necessary mechanisms needed to transmit knowledge and skill in this area to trainees. We will offer educators and supervisors some suggestions on ways in which trainees’ currently less than optimal level of skill in multicultural competency might be enhanced.

Implications for education and practice. We encourage MFT classroom educators to inte- grate as much of an applied focus as possible into their diversity training so as to help students draw specific links between abstract concepts concerning multiculturalism and the clinical reali- ties of working with diverse couples and families. For example, this integration might include

232 JOURNAL OF MARITAL AND FAMILY THERAPY April 2011

the utilization of clinical videos and role plays during classroom teaching so that vague notions such as ‘‘culturally sensitive rapport building’’ can be behaviorally illustrated and made explicit in terms of how it affects therapeutic relationships in couples and family work. Likewise, rather than simply reading about the culturally different ‘‘structural dynamics’’ of racially diverse families, trainees might be allowed to observe the clinical work of skilled practitioners who could readily demonstrate and explain how technical and conceptualization skills differed when working with majority versus diverse family systems.

Conversely, in field practice, we encourage clinical supervisors to directly tie the clinical phenomena that trainees experience with the didactics trainees have acquired in their classroom diversity training. In this way, trainees can increase their ability to understand how culturally sensitive clinical practices fit with the classroom theory and research findings they have learned.

With respect to assessing trainees’ multicultural competencies, we believe a multimodal approach to this process is the best way to track, in a holistic and comprehensive manner, trainee growth in this area. Assessment tools such as academic grades, written and oral conceptualiza- tions, clinical records, in-session behaviors with clients, supervision sessions, self-evaluations, and feedback from clients are all viable data sources reflecting trainees’ development and execution of multicultural counseling competencies. Longitudinal methods such as the utilization of portfolios that assess formative and summative development in multicultural counseling competency are also an excellent way to track and document trainees’ growth (cf. Coleman, 1996). As well, a multi- modal approach helps to decrease the chance that trainee weaknesses in this critical domain will go unnoticed.

Limitations of the Study Our methodology of using vignettes instead of actual clients as stimuli to generate concep-

tualizations may have served to make the stimulus too removed from actual counseling, making the written conceptualization seem less realistic and consequential to participants. Also, because the MCCA task was not related to any consequential evaluation of trainee per- formance (e.g., grades, official ratings from clinical supervisors), the motivation to perform well and comprehensively may have been reduced in trainees. As well, the connection between written or oral conceptualizations with in-session behaviors is not known. Trainees with low scores on the MCCA task may conduct extremely culturally sensitive interviews with couples and families; likewise, high scorers on the written task may not necessarily be highly compe- tent in session with real clients.

Implications for research. One consideration that must be addressed in future research is the possibility that MCCA vignettes may not have the same stimulus value for all participants within (or even across) studies. Previous researchers have created vignettes that clearly demon- strate the potential influence of race on clients’ lives, while others, like ours, may do so more subtly. Regardless, participant mean MCCA scores across past studies were low (Bromley, 2004), as were the scores in our present study. This factor prevents definitive judgments as to whether observed weaknesses lie with trainees’ multicultural conceptualization skills or rather the ability of the MCCA methodology and vignette instruments to consistently tap and validly assess that skill in trainees. Clearly, future investigations into this area need to clarify the role of these and other variables in the MCCA methodology, and any results of studies using the MCCA need to be considered with this context of uncertainty.

CONCLUSIONS

Our study indicates that although the profession of marriage and family therapy has made advances in addressing issues of diversity, students in MFT need more and varied avenues through which they can acquire culturally sensitive professional skills and competencies. MFT educators and supervisors should rely on as many data sources as possible in educating and evaluating trainees’ multicultural counseling competencies. In addition, the provision of extra- curricular diversity training opportunities is valuable in promoting multicultural counseling competencies. Finally, even resource-limited MFT training programs can consider better inte- grating their available academic and clinical experiences in diversity education to help increase

April 2011 JOURNAL OF MARITAL AND FAMILY THERAPY 233

the effectiveness of their training. Through these ministrations, MFT educators, supervisors, and trainees as well as the clientele they serve can all benefit.

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