American Psychologist

© 2019 American Psychological Association 2019, Vol. 74, No. 2, 232–244

0003-066X/19/$12.00 http://dx.doi.org/10.1037/amp0000382

APA Multicultural Guidelines Executive Summary: Ecological Approach

to Context, Identity, and Intersectionality
Caroline S. Clauss-Ehlers David A. Chiriboga
Rutgers, The State University of New Jersey University of South Florida

Scott J. Hunter Gargi Roysircar

The University of Chicago Antioch University New England
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

Pratyusha Tummala-Narra
This document is copyrighted by the American Psychological Association or one of its allied publishers.

Boston College

The initial version of the Multicultural Guidelines, titled Guidelines on Multicultural Education,
Training, Research, Practice, and Organizational Change for Psychologists, was published in
2002. Since then, there has been significant growth in research and theory regarding multicultural
contexts. The revised Multicultural Guidelines are conceptualized to reconsider diversity and
multicultural practice within professional psychology at this period in time, with intersectionality
as its primary purview. Psychologists are encouraged to incorporate developmental and contextual
antecedents of identity and consider how they can be acknowledged, addressed, and embraced to
generate more effective models of professional engagement. The Multicultural Guidelines incor-
porate broad reference group identities that acknowledge within-group differences and the role of
self-definition. Identity is shaped across contexts and time by cultural influences including age,
generation, gender, gender identity, ethnicity, race, religion, spirituality, language, sexual orien-
tation, social class, education, employment, ability status, national origin, immigration status, and
historical as well as ongoing experiences of marginalization. The theoretical model, a layered
ecological model of the Multicultural Guidelines, is presented along with 10 corresponding
guidelines. The guidelines are applicable to psychologists in their work with clients, students,
research participants, and in practice, education, research, and/or consultation.

Keywords: multicultural guidelines, ecological, intersectionality, identity

The purpose of the Multicultural Guidelines is to provide education. The complete guidelines and related appendices can
psychologists with a framework from which to consider be found at http://www.apa.org/about/policy/multicultural-
evolving parameters for the provision of multiculturally com- guidelines.aspx (American Psychological Association [APA],
petent services that include practice, research, consultation, and 2017). The original Guidelines on Multicultural Educa-

Caroline S. Clauss-Ehlers, Graduate School of Education, Rutgers, The Policy Unit at the University of York are acknowledged for the support
State University of New Jersey; David A. Chiriboga, Department of Child & provided during a sabbatical leave.
Family Studies, University of South Florida; Scott J. Hunter, Departments of The Task Force appreciates BAPPI’s consistent support, extensive re-
Psychiatry and Behavioral Neuroscience, and Pediatrics, The University of views, and substantive feedback. Task Force members also express their
Chicago; Gargi Roysircar, Department of Clinical Psychology, Antioch Uni- appreciation to the individuals and groups who provided insightful feed-
versity New England; Pratyusha Tummala-Narra, Department of Counseling, back during the public review process.
Developmental & Educational Psychology, Boston College. Appreciation is extended to Clinton W. Anderson, Interim Executive Di-
After the first author, the authors are listed by last name alphabetically. rector of the APA Public Interest Directorate, for his support in bringing this
The Task Force gratefully acknowledges the earlier pioneering work of document to fruition, and to Sue Houston, who was responsible for assisting
multiple individuals, whose steadfast commitment over several years and the Task Force in its work and who played an instrumental role in shepherding
extensive knowledge of history and subject matter made this work possible. the document through the final approval process. The Task Force is also
BAPPI liaisons April Harris-Britt and Gayle Skawennio Morse provided grateful for the contributions of students Cara Lomaro and Noël Su.
vital guidance and invaluable collaboration. Sincere appreciation is ex- Correspondence concerning this article should be addressed to Caroline
tended to Renato Alarcón, William D. Parham, and Terrence Roberts for S. Clauss-Ehlers, Graduate School of Education, Rutgers, The State Uni-
their willingness to contribute their invaluable knowledge, encouragement, versity of New Jersey, 10 Seminary Place, New Brunswick, NJ 08901.
and assistance. Roy Sainsbury, Sally Pulleyn, and the Social Research E-mail: [email protected]

232
 APA MULTICULTURAL GUIDELINES EXECUTIVE SUMMARY 233

Theoretical Framework: A Layered Ecological

Model of the Multicultural Guidelines
The Multicultural Guidelines Task Force model, a lay-
ered ecological model of the Multicultural Guidelines,
incorporates Bronfenbrenner’s (1977, 1979) ecological
model that proposed five nested, concentric circles: (a)
the microsystem of immediate family, friends, teachers,
and institutions that have direct influence on the individ-
ual; (b) the mesosystem that refers to interrelations of
various social entities found in the microsystem that
affect a person’s life (e.g., home, school, community); (c)
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

the exosystem that deals with societal and cultural forces,

This document is copyrighted by the American Psychological Association or one of its allied publishers.

including public policies, laws, and governmental influ-

ences, that act upon the individual without necessarily
having a direct link to individual experience; (d) the
macrosystem that corresponds with the cultural context in
which the individual lives, such as cultural values and
norms; and (e) the chronosystem that deals with the
Caroline S. passage of time, historical trends and transitions, and the
Clauss-Ehlers historical context surrounding individual experience.

Description of the Current Model

tion, Training, Research, Practice, and Organizational The ecological model comprises dynamic, nested sys-
Change for Psychologists (APA, 2002) were based on the tems that transact over time. Figure 1 illustrates five
work of Sue and colleagues (1982), who presented a levels of the model. Level 1: Bidirectional Model of
model of cross-cultural counseling competencies Self-Definition and Relationships is represented by the
(MCCs). As discussed in the Report of the Task Force on two inner circles that capture a bidirectional model of
the Implementation of the Multicultural Guidelines self-definition and relationships. The circle on the left
(APA, 2008), “the origins of the Multicultural Guidelines represents the individual’s self-definition in the roles of
are rooted in various social, historical, and political client, student, research participant, or consultee. The
events and inspired by a number of professional devel- circle on the right represents the individual’s self-
opments in the field of psychology” (p. 4), and within definition in the roles of clinician, educator, researcher,
APA itself, over the past 50 years. The goal of this new or consultant; these may also involve more than two
version is to consider the term multicultural in its broad- people, for example, a couple, family, group, or research
est conceptualization reflecting current literature that sample. The bidirectional arrow that intersects the two
considers contextual factors and intersectionality, includ- circles represents the bidirectional relationships consid-
ing age, generation, culture, language, gender, race, eth- ered within the model. Level 2: Community, School, and
nicity, ability status, sexual orientation, gender identity, Family Context refers to the model’s second layer. Spe-
cific areas considered include family, community,
socioeconomic status, religion, spirituality, immigration
school, neighborhood, workplace, place of worship, and
status, education, and employment, among other vari-
physical space. The context presented in Level 2 has
ables; these identities are considered within the context
direct influence on the bidirectional relationships de-
of domestic and international climates and human rights.
scribed in Level 1. Level 3: Institutional Impact on
This iteration recognizes contributions of culturally compe- Engagement examines the effects of institutional context
tent models of practice such as the American Counseling on how clients and psychologists experience the commu-
Association’s Multicultural and Social Justice Counseling nity, school, and family contexts (Level 2) and how this
Competencies: Guidelines for the Counseling Profession experience influences both the individual’s self-
(Ratts, Singh, Nassar-McMillan, Butler, & McCullough, definition and relationships with one another (i.e., client,
2016), the American Psychiatric Association’s Cultural student, consultee, research participant and clinician, ed-
Formulation Interview (APA, 2013), and the National As- ucator, researcher, consultant [Level 1]). Level 4: Do-
sociation of Social Workers’ (NASW) Standards and Indi- mestic and International Climate considers the impact of
cators for Cultural Competence in Social Work Practice the domestic climate (on the circle’s left-hand side) and
(National Association of Social Workers, 2015). the international climate (on the circle’s right-hand side).
 234 CLAUSS-EHLERS ET AL.

layer) around Levels 1–5 to show that they drive the eco-
logical model. Power–privilege represents a continuum of
power and privilege that can be experienced by participants
engaged in psychological endeavors as well as by psychol-
ogists providing services. Tensions between and among
Levels 1–5 are dynamic and contextual and may result
through intersections between and among various levels.
Fluidity refers to the dynamic interaction between and
among concentric circles and shifts within them. The up-
ward facing arrow labeled resilience and the downward
facing arrow labeled trauma represent the goal of increasing
resilience and decreasing trauma.
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Documentation of Need–Distinction Between

Standards and Guidelines
APA distinguishes between standards (e.g., mandates
that psychologists must adhere to) and guidelines (e.g.,
aspirational and informative; “2010 Amendments,” 2010;
David Chiriboga APA, 2015b). Psychologists are encouraged to use the
Multicultural Guidelines in tandem with the Ethical Prin-
This fourth layer encompasses Levels 1–3. At the top of ciples of Psychologists and Code of Conduct (APA, 2002,
this fourth circle is consideration of the larger societal amended in 2010) and to be aware that state and federal
context and at the bottom is consideration of human laws may override them and take precedence (“2010
rights. Level 5: Outcomes encompasses all prior levels Amendments,” 2010; APA, 2015b). The Multicultural
and refers to those results, both positive and negative, Guidelines refer to psychological practice (e.g., clinical
that are derived from the bidirectional transactions be- work, consultation, education, research, and training)
tween the client, student, research participant, and con- rather than treatment guidelines; the latter are client-
sultee and the clinician, educator, researcher, and con- focused and address intervention-specific recommenda-
sultant. Outcomes are influenced by interactions and tions for clinical populations or conditions (Reed,
experiences with Levels 1, 2, 3, and 4. McLaughlin, & Newman, 2002). The guidelines are con-
sistent with the APA Ethical Principles of Psychologists
Dynamic Processes
and Code of Conduct and the Standards of Accreditation
Three dynamic processes—power–privilege, tensions, and for Health Service Psychology (APA, 2015b; APA, Com-
fluidity—influence the model, creating a circle (or another mission on Accreditation, 2015).

Figure 1. Ecological model of the Multicultural Guidelines.

 APA MULTICULTURAL GUIDELINES EXECUTIVE SUMMARY 235

“border crossing,” where individuals can experience hy-

bridity as a reference point for identity (Root, 2003, p.
36). Research has indicated that identity varies across
different sociocultural groups as well as within such
groups (Comas-Díaz, 2012; Sue & Sue, 2016). Language
describing identity (e.g., identity labels) conveys percep-
tions of and feelings about a particular group. For exam-
ple, the use of pronouns among people with nonbinary
gender identities, such as zie instead of she or he, moves
society toward more accurate perceptions and conceptu-
alizations of gender experiences. Identity development is
dynamic and fluid, influenced by structural and interper-
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sonal factors that may either constrain or expand possi-

This document is copyrighted by the American Psychological Association or one of its allied publishers.

bilities for the expression of various experiences. Psy-

chologists strive to attend to intersecting social, cultural,
neurobiological, economic, and political contexts that
contribute to an individual’s diverse identities (Cho,
Scott J. Hunter Crenshaw, & McCall, 2013).
Photo by
Joe Mazza, Brave Applications to Practice, Research,
Lux, Chicago
and Consultation
Practice. Psychologists are encouraged to strive toward
Level 1 Guidelines: Bidirectional Model of Self- attunement to life experiences, transitions, and identity la-
Definition and Relationships bels and how identity experience may change over time and
Guideline 1: Psychologists seek to recognize and understand context (Hays, 2016; Tummala-Narra, 2016). Regarding
that identity and self-definition are fluid and complex and that assessment and psychotherapy, clinicians can invite clients
the interaction between the two is dynamic. To this end, to describe their identities and labels, rather than relying on
psychologists appreciate that intersectionality is shaped by the preconceived conceptualizations. Clinicians, researchers,
multiplicity of the individual’s social contexts. educators, and consultants can attend to language that is
affirming of an individual’s or group’s actual identity ex-
Identity reflects both individual and collective features
periences and can recognize that this language may change
of emotional and cognitive experience and develops
over time (APA, 2015b).
within interpersonal and structural contexts. Identity can
Research. Intersectionality research focuses on the dy-
be conceptualized as an internal experience of “subjec-
namics of power in the multiple systems that shape and limit
tive self-sameness” that facilitates emotional experiences
differing levels of agency an individual person possesses in
and behaviors that reflect an individual’s actual or true
society. Intersectional researchers (cf. Sirin & Fine, 2008)
self (Mann, 2006, p. 216). Identity develops across con-
have demonstrated that scholars can attend to structural
texts and time and is shaped by cultural influences in-
dynamics resulting in social identities through the use of
cluding age, generation, gender, ethnicity, race, religion,
qualitative and quantitative research designs as well as
spirituality, language, sexual orientation, gender identity,
interdisciplinary research teams (e.g., comprised of psy-
social class, education, employment, ability status, national
chologists, sociologists, political scientists, women studies
origin, immigration status, and historical as well as ongoing
faculty, ethnic studies faculty, legal scholars). Greater col-
experiences of marginalization, among other variables
laboration with individuals and communities has been a
(Comas-Díaz, 2012; Roysircar-Sodowsky & Maestas, 2000).
core foundation of modern socioneurobiological approaches
Various dimensions of identity associated with socio-
to contextual research regarding identity and affiliation.
cultural contexts have been described in psychological
Consultation. Consultants aim to address organiza-
theories (Cross, 1991). For example, racial identity has
tional issues that may stem from a lack of understanding
been described as a sense of collective identity rooted in
related to identity. Consultants are also responsible for
individuals’ perception that they share a common heri-
educating and collaborating with their clients (e.g., individ-
tage with a specific racial group (Helms & Cook, 1999),
uals, groups, communities) about the importance of respect-
and ethnic identity has been defined as the extent to
ing their own and others’ self-definitions of identity.
which individuals identify as members of their ethnic
group(s) (Phinney, 1996). Biracial identity and multira- Guideline 2: Psychologists aspire to recognize and understand
cial identity have been described as involving a sense of that as cultural beings, they hold attitudes and beliefs that can
 236 CLAUSS-EHLERS ET AL.

plicable to individuals, communities, and organizations with

which they interact. A focus on intersectionality increases
the capacity psychologists have for considering the multi-
tude of positions and components of identity and person-
hood that exist within an array of communities, individuals,
educational settings, and organizations.

Applications to Practice, Research,

and Consultation
Practice. Psychologists are encouraged to consider the
role of their worldviews and sociocultural histories in their
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

clinical observations in assessment, interpretation of psy-

This document is copyrighted by the American Psychological Association or one of its allied publishers.

chological tests, and formulation of diagnoses. Psycholo-

gists are encouraged to be aware that stereotypic thinking
and overgeneralization may lead to engaging in inaccurate
assessment and misdiagnosis, inappropriate treatment, and
harmful microaggressions in research and clinical settings.
This multicultural approach reveals psychologists’ cultural
humility (Hook & Watkins Jr., 2015).
Gargi Roysircar Research. A collaborative approach that values the per-
spectives and sociocultural locations and identities of re-
influence their perceptions of and interactions with others as search participants, as well as the self-reflexivity of the
well as their clinical and empirical conceptualizations. As researcher(s), is a hallmark of culturally informed empirical
such, psychologists strive to move beyond conceptualizations studies. Research concerning interactive aspects of cultural
rooted in categorical assumptions, biases, and/or formulations worldviews and experiences can provide a better self-
based on limited knowledge about individuals and understanding by psychologists of their own role as cultural
communities. beings. This in turn facilitates understanding of participant
identities and self-definitions to avoid categorizing/over-
Psychologists’ worldviews are rooted in their professional
generalizing experiences.
knowledge, personal life experiences, and interactions with
Consultation. It is important that psychologists cre-
others across their ecological contexts, and these world-
ate a space that offers a basic sense of respect where
views influence empirical and clinical conceptualizations
supervisors initiate discussion with supervisees about
and approaches. Both conscious and unconscious factors
their experiences of the supervision. It is also necessary
may lead psychologists toward unwarranted assumptions
that supervisors and educators work through their reac-
about the client or data. Scholars have documented preva-
tions to experiences such as racial and gender socializa-
lent overt and subtle discrimination, as well as conscious
tion, as well as sociocultural oppression and privilege
and unconscious (e.g., implicit, aversive) stereotyping of
(Tummala-Narra, 2016). Education in psychology can
and bias against women, racial and ethnic minorities, sexual
include models that focus on multicultural considerations
minorities, religious minorities, transgender and gender-
across the life span throughout a curriculum. In a similar
nonconforming individuals, older adults, people with dis-
way, multicultural education is not intended to be pro-
abilities, and people from low-income backgrounds, among
vided solely by faculty who identify as minorities (e.g.,
other groups. Their negative effects on mental health out-
racial, gender, or sexual), because this contributes to the
comes, such as depression, anxiety, and suicidal ideation,
problem of categorization and marginalization within
and on health disparities have been documented (Goodley &
psychology. It dismisses the importance of having faculty
Runswick-Cole, 2011). Psychologists’ knowledge of cul-
from all sociocultural backgrounds invest their time and
tural norms, beliefs, and values of clients, as well as socio-
resources to address multicultural issues.
political influences, such as racism, xenophobia, Islam-
ophobia, anti-Semitism, sexism, transphobia, cisgenderism,
homophobia, heterosexism, classism, and ableism, influ- Level 2 Guidelines: Community, School, and
ences the therapeutic relationship and, therefore, is a critical Family Context
part of culturally informed practice. Guideline 3: Psychologists strive to recognize and understand
Although recognizing the limitations of earlier models the role of language and communication through engagement
of psychotherapy and research, psychologists apply their that is sensitive to the lived experience of the individual,
knowledge to determine the models and theories most ap- couple, family, group, community, and/or organizations with
 APA MULTICULTURAL GUIDELINES EXECUTIVE SUMMARY 237

Applications to Practice, Research,

and Consultation
Practice. Psychologists strive to engage in develop-
mentally appropriate communication efforts that seek to
understand how people, communities, and organizations
self-identify and subsequently follow the lead presented by
that individual’s or group’s identification, including an
awareness of and responsiveness to nonverbal forms of
communication. Psychologists strive to be aware of the use
of interpreter guidelines when not versed in the language of
the client. Psychologists working with interpreters can form
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a collaborative partnership that promotes understanding of

This document is copyrighted by the American Psychological Association or one of its allied publishers.

the client’s experience. When psychologists reflect the same

language background as their client, whether it is a mono-
lingual, bilingual/bicultural, or multilingual/multicultural
experience, they are encouraged not to assume sameness
between themselves and the client but rather to understand
that language and culture may be experienced differently,
Pratyusha even when a shared language exists. Issues with the appli-
Tummala-Narra cation of standardized assessments to linguistically and
culturally diverse communities include norms not being
developed in the language of or for the population in which
whom they interact. Psychologists also seek to understand the assessment is being administered. Test items may reflect
how they bring their own language and communication to the dominant culture in which the assessment was devel-
these interactions. oped rather than the examinee’s heritage culture, compro-
mising interpretation and applicability.
Psychologists are encouraged to consider the role of lan-
Research. Research psychologists are encouraged to
guage in their professional relationships as well as within
incorporate local terms or phrases in research protocols to
the context of the client’s experience. The role of language
make the research more relevant to a participant’s experi-
and communication for the individual, couple, family,
ence. Psychologists are encouraged to be aware of the role
group, community, and/or organization relates to the fact
of language and informed consent to participate in research
that a language’s intrinsic connection to culture can reflect
(e.g., provide informed consent documents written in the
social identity (Chiu & Chen, 2004). Psychologists also research participant’s primary language or read aloud for
bring language and communication styles (both verbal and those unable to read).
nonverbal) that reflect their lived experiences. Psycholo- Consultation. Psychologists are encouraged to be at-
gists can seek to recognize the cognitive and affective tentive to the language(s) of the organization, as communi-
components of bilingualism and multilingualism, psycho- cated by multiple constituencies, to develop a broad under-
logical meanings associated with each language, and the standing of organizational issues. Consulting psychologists
connection between cultural values and identity associated can act as conveners, bringing groups together to discuss
with each language. Psychologists may engage in code experiences across organizational constituencies that may
switching, engaging both professional and personal lan- not understand one another.
guage, to more fully enter and participate in a client’s world
(Clauss-Ehlers, 2006). Psychologists are encouraged to be Guideline 4: Psychologists endeavor to be aware of the role of
aware of intergenerational language use, intergenerational the social and physical environment in the lives of clients,
relationships, and intergenerational conflicts that influence students, research participants, and/or consultees.
communication within a societal and cultural context. In a Immediate social and physical environments provide
related vein, psychologists strive to be aware of how lan- many of the resources that affect people’s lives. These
guage varies according to developmental stage and the resources represent what is sometimes called social capital
impact this variability has on individuals’ lives, as well as and include factors such as the overall wealth and safety of
on clinical, educational, research, and consultative interac- neighborhood, quality of schools, pollution and other envi-
tions. Psychologists are encouraged to be aware of commu- ronmental hazards, quality and accessibility of the health
nication between cisgender and transgender and gender care and transportation systems, and availability of nutri-
nonconforming individuals. tious food (Kawachi, Subramanian, & Kim, 2008). A
 238 CLAUSS-EHLERS ET AL.

resource-rich environment can maximize the potential for a early or cumulative exposure to adverse environments may
quality life, as well as for a successful resolution of a be difficult to resolve, those that result from social trajec-
client’s problems, whereas a resource-poor environment can tories may be more amenable to environmental interven-
minimize these potentials (Healthy People, 2017). Psychol- tions. Examples include efforts to reduce crime or gun
ogists are encouraged to attend to resources available to violence or to improve educational or health care systems.
clients, both now and in the past, including barriers to health
care services, the quality of such services, and other social
and physical environmental factors. Level 3 Guidelines: Institutional Impact
Psychologists are encouraged to recognize that environ- on Engagement
mental factors do not detract from the importance placed on
a client’s personal and perceived world. Rather, they en- Guideline 5: Psychologists aspire to recognize and understand
courage awareness of how life is experienced in the context historical and contemporary experiences with power, privi-
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lege, and oppression. As such, they seek to address institu-

of the social and physical environments where the client
This document is copyrighted by the American Psychological Association or one of its allied publishers.

tional barriers and related inequities, disproportionalities, and

lives. The location of schools, police departments, clinics
disparities of law enforcement, administration of criminal
and hospitals, and even grocery and department stores, all of
justice, educational, mental health, and other systems as they
which represent elements of the so-called built environment
seek to promote justice, human rights, and access to quality
(Opotow, 2018), can also be accessed, as can crime statis- and equitable mental and behavioral health services.
tics. Addressing challenges to physical access to critical
resources for people with disabilities is important to con- Psychologists are encouraged to understand structural
sider. Psychologists can also explore the influence of social oppression embedded in institutional practices that pro-
media on individuals and communities and how it can be duce disparities, disproportionalities, and inequities and
both a resource and a stressor. to pursue an ongoing self-reflective process of their own
social position. There are significant disparities in equi-
table treatment across the legal system. Profiling by the
Applications to Practice, Research,
police targets individuals for suspicion of crime based on
and Consultation
race, ethnicity, religion, immigration status, or national
Practice. Clients from low-resource neighborhoods origin, resulting in people of color being disproportion-
may present with problems exacerbated by living in neigh- ately stopped, questioned, and ultimately arrested. Schol-
borhoods characterized by poverty, poor health care, lack of ars have attributed this inequality to disparate criminal
access to health care and disability services, high crime rates justice policies and implicit racism in decision-making
that lead to chronic fears for personal safety, few public among law enforcement and justice officials (Mauer,
spaces, and inadequate staffing and resources in schools. 2011). Although legal segregation ended 60 years ago,
Individuals living in low-resource environments, including schools continue to be socially segregated by race, eth-
both those from historically discriminated groups and more nicity, and class. Urban schools are marked by class
mainstream, may be more likely to receive lower quality segregation that intersects with ethnicity and low English
care from health services and face more barriers to access- proficiency (National Center for Education Statistics,
ing care.
2016). Forty percent of urban students attend high pov-
Research. Various physical health problems, such as
erty schools in comparison to 10% of suburban and 25%
mortality, cardiovascular disease, diabetes, asthma, and
of rural students. Class inequality occurs in college ac-
obesity, are disproportionately represented among persons
cess and intersects with racial/ethnic disparities.
living in low-resource neighborhoods (Diez Roux & Mair,
As one example, barriers associated with mental health
2010). The reasons for these disparities, however, are com-
plex and deserve researchers’ attention. For example, how service utilization among immigrant populations can be
can barriers to health care resulting from safety and other characterized by examining dropping out of treatment and
socioenvironmental factors be minimized for those with not seeking it, or waiting until symptoms become debilitat-
mobility impairments? Although rarely studied, higher lev- ing (Dow, 2011). Potential reasons include a cultural dis-
els of depressive symptomatology have also been reported connect with Western conceptualizations and treatment,
in low-income areas (e.g., Diez Roux & Mair, 2010), as has language barriers, and misdiagnosis (Dow, 2011). Many
the disproportionate numbers of LGBTQ⫹ youth in the refugees and asylees, despite various physical and mental
juvenile justice system (e.g., Allen, Ruiz, & O’Rourke, health concerns, avoid public programs and assistance, due
2016). to the fear of losing legal status. Additionally, religion and
Consultation. What Berkman (2009) referred to as “so- religious oppression can intersect with other social catego-
cial trajectory” is of particular interest to consulting psy- ries, such as race, gender, sexual orientation, gender iden-
chologists (p. 34). Whereas health problems that result from tity, ability, or class status.
 APA MULTICULTURAL GUIDELINES EXECUTIVE SUMMARY 239

Applications to Practice, Research, multidisciplinary services provided for children from birth to
and Consultation 5 years of age to promote child health and well-being, enhance
emerging competencies, minimize developmental delays, re-
Practice. Psychologists are encouraged to make diag- mediate existing or emerging disabilities, prevent functional
noses and conduct assessments that are culturally tailored deterioration, and promote adaptive parenting and overall
and ecologically relevant and to consider preimmigration family functioning (pp. xvii–xviii).
vulnerabilities (e.g., religious persecution, torture, rape,
Effective prevention programs are informed by the con-
flight, and relocation camps) and postimmigration stressors
textual needs of the community they are designed to serve.
(e.g., underemployment, absence of support, rejection by
the host society, identity conflicts, and acculturative stress;
Roysircar, 2004). Refugees who have been resettled are Applications to Practice, Research,
likely grieving multiple losses, including loss of role, com- and Consultation
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

munity, and supports. Practice. Psychologists are encouraged to be aware of

This document is copyrighted by the American Psychological Association or one of its allied publishers.

Research. Research can be dynamically focused on the cultural differences in perceptions of mental health and its
multiple arenas of health care and service delivery. These significance and to consult the science of prevention and
may include access to and awareness of health care options; intervention, especially with respect to evidence-based sup-
utilization; help-seeking attitudes; mainstream stigma of port for culture-centered interventions (Zane, Bernal, &
marginalized societies; cultural stigma; individuals’ inter- Leong, 2016). Relationship-centered advocacy emphasizes
nalized stigma; sensitivity to between and within-group developing a mutually collaborative relationship based on a
differences; and immigrant and refugee perceptions on social justice framework. Through advocacy efforts, psy-
health care options, delivery processes, and treatment out- chologists participate in a “cooperative community” (Gee et
comes. al., 2015, p. 2) that seeks to improve the lives of those
Consultation. Psychologists are encouraged to consult struggling with mental health issues.
with nongovernmental organizations and community groups Research. Researchers are encouraged to foster the de-
to identify specific problems to be solved that reflect ineq- velopment of the science of culture-centered interventions
uitable access including alternative service delivery. (Zane et al., 2016). Psychologists strive to seek research
participants who are diverse across multicultural variables
Guideline 6: Psychologists seek to promote culturally adap-
so that findings reflect the needs of specific populations and
tive interventions and advocacy within and across systems,
including prevention, early intervention, and recovery.
respond to gaps in the literature by developing or applying
research measures that address multicultural contexts. Test-
The term culture-centered interventions (Pederson, 1997) ing and development of measures in different languages and
refers to efforts that view the integration of culture and among diverse cultures is critical to the development of the
language as central to the delivery of services. Related work literature on culture-centered interventions and measures
has considered the role of culturally centered psychologists with culturally sound psychometric findings.
as a tool in the provision of culturally and linguistically Consultation. Psychologists are encouraged to engage
relevant clinical services, the development of rapport from in consultation that furthers the development and implemen-
a cross-cultural framework (Hays, 2016; Tummala-Narra, tation of culture-centered interventions. Consulting psy-
2016), and social justice efforts to decrease health dispari- chologists strive to support advocacy efforts that promote
ties through the provision of culturally centered service access to care and further develop a culturally centered
delivery and development of more culturally responsive mental health infrastructure.
infrastructures. Research has found significant differences
across communities in terms of access and utilization of Level 4 Guidelines: Domestic and
services (U.S. Department of Health and Human Services International Climate
[USDHHS], 2001).
Advocacy, prevention, and early intervention. Guideline 7: Psychologists endeavor to examine the profes-
Psychologists are encouraged to identify ways in which they sion’s assumptions and practices within an international con-
may serve as advocates for system change or “collective text, whether domestically or internationally based, and con-
mental health advocacy” (Gee, McGarty, & Banfield, 2015, sider how this globalization has an impact on the
psychologist’s self-definition, purpose, role, and function.
p. 1; Stringfellow & Muscari, 2003).
Primary prevention efforts are designed to prevent the Psychologists, although acting locally, aspire to think
development of issues such as school violence, anxiety globally and understand human conditions within broad
disorders, and internalizing/externalizing mental health global systems. International psychology represents a post-
problems in response to various content areas. Early inter- modern form of consciousness, with psychologists theoriz-
vention (Shonkoff & Meisels, 2000) refers to ing about universal conditions while also operationalizing
 240 CLAUSS-EHLERS ET AL.

culture-specific manifestations of a universal experience. tural and transnational people, and the experiences of inter-
The United States’ involvement in globalization requires national adoptees. Psychologists are encouraged to consult
attention. The U.S. military covers 75% of the world’s with local nongovernmental organizations, health clinics,
nations and is deployed in more than 150 countries, with and stakeholders to develop local regulatory standards for
over 130,000 of active-duty personnel (Vine, 2015). The their research.
effect of U.S. wars (e.g., Operation Iraqi Freedom, Opera- Consultation. Psychologists are encouraged to consult
tion Enduring Freedom in Afghanistan) has made posttrau- about accessible, equitable, and effective global mental and
matic stress disorder (PTSD), traumatic brain injuries, and behavioral health care and the impact of economic global-
military suicide prevalent, affecting thousands of soldiers ization.
and millions of family members (Shen, Arkes, Kwan, Tan,
Guideline 8: Psychologists seek awareness and understanding
& Williams, 2010). The number of international students at of how developmental stages and life transitions intersect with
American colleges and universities grew by 7.1% to over the larger biosociocultural context, how identity evolves as a
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

one million in 2015–2016. An estimated 10% of all Amer- function of such intersections, and how these different social-
This document is copyrighted by the American Psychological Association or one of its allied publishers.

ican undergraduates studied abroad (Open Doors, 2016). ization and maturation experiences influence worldview and
Another area of international psychology is transnational- identity.
ism, defined as “the ability of individuals and families to
travel and maintain relationships across national borders” An individual’s life cycle is heavily influenced not only
(Byng, 2017, p. 131). Unaccompanied minors (i.e., children by the immediate social and physical environment but also
and adolescents who arrive in the United States without by current societal trends and historical period. For exam-
their parents or primary caregivers) are a growing commu- ple, wars and economic depressions affect individuals at all
nity in U.S. and Canadian schools. Third culture kids are stages of the life cycle; however, the effects may differ
U.S. children and adolescents being raised in countries other depending on age or experiential history (Takizawa,
than their passport country, who upon return to their birth– Maughan, & Arseneault, 2014). Some historical periods,
first country may face stress and/or trauma from feeling a such as the continuing impact of America’s period of slav-
lack of belonging in their countries of origin (Pollock & ery and genocide, have a lasting influence. For these rea-
Van Reken, 2009). Increased possibilities of communicat- sons, psychologists seek to develop and sustain an aware-
ing across the globe through the Internet allow people to ness of how an individual’s identity has changed over time
pursue connections and attachments so that the quest for and how the person’s identities, and the salience of each of
discovery of new lands and people can easily shift from these identities, are affected by the historical period and the
fantasy to reality and vice versa. concurrent immediate developmental, social, and familial
contexts within which the individual is situated. To date,
only minimal attention has been paid to considering inter-
Applications to Practice, Research, sectionality from the perspective of developmental stage
and Consultation and historical time, but the available literature supports the
necessity of doing so (e.g., USDHHS, 2001).
Practice. U.S. psychologists aspire to prevent coloniza-
tion of indigenous or culture-specific systems of health care.
Applications to Practice, Research,
Psychologists are encouraged to export cultural empathy
and Consultation
that is steeped in a sense of mutuality, openness, and deep
empathic attunement. Partnerships between primary health Practice. Psychologists attend to the impact that inter-
care systems of other nations and U.S. behavioral health ventions may have on community identity and understand-
practices are needed for integrated treatment and increased ing. For example, a majority of children with profound
human resources. U.S. psychologists in international pri- hearing loss are born to parents without hearing loss (Na-
mary care settings can broadly address in a limited number tional Institute on Deafness and Other Communication Dis-
of short sessions an array of problems (i.e., medical, psy- orders, 2016), and nearly 60,000 children in the United
chosomatic, relational, and culture-bound syndromes). States had received cochlear implants by 2012. Such im-
Research. Research is needed on the nature and status plants have been a point of controversy in the deaf commu-
of mental health professions in different countries to under- nity, because many activists feel that a hearing “impair-
stand the feasibility of a global helping paradigm to link ment” is neither an impairment nor a disability and look
psychology, psychotherapy, and indigenous healing across unfavorably on implants (Sparrow, 2005) as a challenge to
national boundaries. Many areas of research that intersect deaf culture. They seek a broader consideration by profes-
domestic and international psychology are understudied, sionals of the option to allow a child to grow up as deaf and
areas such as those focused on structural forms of stigma not to stigmatize that option.
(e.g., homophobia, transphobia) and their impact on indi- Research. Psychologists are encouraged to recognize
viduals and communities, the adaptation among transcul- various models of identity (e.g., Phinney, 1996). Further
 APA MULTICULTURAL GUIDELINES EXECUTIVE SUMMARY 241

research is needed on the multidimensional aspects of ethnic gender identity, and unfamiliarity with research or with the
identity and developmental influences on individuals’ inter- health care system. Psychologists recognize these barriers
sectional identities. When conducting research, psycholo- and seek to improve rapport.
gists seek to pay close attention to and inform themselves of Research. Given their reliance on primarily non-
intersectional considerations that participants present and Latino/Hispanic/Latinx, White/White American samples,
how these influence interpretations of findings regarding psychologists strive to recognize that the often-limited gen-
self, identity, group membership, and the consistency of eralizability of randomized controlled trials may reduce the
presentation across groups of a psychological phenomenon effectiveness of resulting evidence-based treatments (EBTs)
or concept. with diverse groups (Southam-Gerow, Rodríguez, Chorpita,
Consultation. Psychologists are encouraged to recog- & Daleiden, 2012). Culturally adapted interventions have
nize the multiple and often unique factors underlying how demonstrated efficacy (Bernal & Domenech Rodríguez,
well individuals thrive and meet goals during different 2012). There is a need for establishing the effectiveness of
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

stages of the life course. EBTs for specific groups with a history of discrimination
This document is copyrighted by the American Psychological Association or one of its allied publishers.

and systematic disadvantage. Culturally adapted research

Level 5 Guidelines: Outcomes and intervention is a hallmark of community-based partic-
ipatory research (CBPR; Jernigan, Jacob, Styne, & the
Guideline 9: Psychologists strive to conduct culturally appro- Tribal Community Research, 2015). CBPR and other
priate and informed research, teaching, supervision, consulta- community-engaged research approaches involve working
tion, assessment, interpretation, diagnosis, dissemination, and closely with community members as partners and stake-
evaluation of efficacy as they address the first four levels of holders and can improve recruitment of diverse groups,
the Layered Ecological Model of the Multicultural Guidelines. resolve potential problems of the community’s trust or
Psychologists acknowledge that assessment tools and nearly interest, reduce attrition, and improve cultural appropriate-
all clinical interventions have the potential to mischaracterize ness.
or even miss the behavioral health needs of diverse populations Consultation. Glover and Friedman (2015) contend that
due to cultural and regional differences, stigma, literacy (in- when consulting with persons from diverse cultural groups,
cluding health), the unique presentation of symptoms, expla- psychologists check their “cultural baggage” (p. 149). At issue
nations of psychological distress, and distrust of providers and is viewing clients/organizations from their own biased perspec-
authority in general, among other factors (Sue & Sue, 2016). tive. The consultant may wish to encourage the use of mixed
Focus groups and community involvement are forms of qual- methodologies where qualitative strategies can inform investi-
itative research that may be helpful in the early stages of gators of the validity of quantitative results.
cultural adaptation of psychological practices (Ramos &
Alegría, 2014). Further, psychologists recognize that they do Guideline 10: Psychologists actively strive to take a strength-
based approach when working with individuals, families, groups,
not work in isolation from the community. There is a respon-
communities, and organizations that seeks to build resilience and
sibility to ensure sufficient outreach to allow community feed- decrease trauma within the sociocultural context.
back and monitoring of services and to ensure that providers
are well versed in the practice of multicultural competence and A strength-based approach seeks to consider and in-
that community members themselves have had educational corporate the positive attributes that diverse individuals,
opportunities designed to inform them of signs and symptoms families, groups, and organizations bring to their experi-
of behavioral health problems and how to access services ences. Psychologists who operate from a strength-based
(Chiriboga & Hernandez, 2015). perspective acknowledge challenges while also identify-
ing positive ways in which diverse individuals, families,
groups, communities, and organizations address life ex-
Applications to Practice, Research,
periences. Resilience is one aspect of the strength-based
and Consultation
approach that refers to the “process, capacity or outcome
Practice. Psychologists are aware that dropout rates of successful adaptation despite challenges or threatening
among persons of color recruited for studies or participating in circumstances . . . good outcomes despite high risk status,
interventions are generally higher than those found among sustained competence under threat and recovery from
non-Latino/Hispanic/Latinx, White/White American research trauma” (Masten, Best, & Garmezy, 1990, p. 426). Re-
participants and clients (Zane et al., 2016). Among the rea- cent models incorporate sociocultural context into an
sons are problems with developing a therapeutic or research understanding of resilience and how social position fac-
alliance, distrust, or a feeling that the intervention or re- tors can either promote or inhibit positive development
search lacks relevance to the individual’s life. Others may (Clauss-Ehlers, 2008; García Coll & Marks, 2012; Roy-
be reluctant to participate in research or therapy due to their sircar, Colvin, Afolayan, Thompson, & Robertson,
legal status, stigma associated with mental health disorders, 2017). Culturally focused resilient adaptation is “a dy-
 242 CLAUSS-EHLERS ET AL.

namic, interactive process in which the individual nego- Guideline Application: A Case Illustration
tiates stress through a combination of character traits,
cultural background, cultural values, and facilitating fac- A novel element with the revised Multicultural Guidelines is
tors in the sociocultural environment” (Clauss-Ehlers, the cases developed for each guideline, which serve as teach-
2004, p. 36). ing tools to highlight their application. The following presents
Although trauma is a universal experience, psychologists a summary of Anthony’s experience (the name is a pseudonym
are encouraged to consider the cultural context in which and based on a composite of clients; see http://www.apa.org/
traumatic events unfold. The interpretation of and response about/policy/multicultural-guidelines.PDF for the complete
to trauma may be shaped by cultural constructs such as case). It highlights key themes reflected in Guideline 4, with its
societal norms focused on individualism versus collectivism focus on the social and physical environment, and incorporates
(i.e., a focus on the individual vs. a focus on the group), developmental and ability status-related considerations.
religion and spirituality, body and mind (i.e., connections Anthony, a 25-year-old, cisgender, biracial/multiethnic man,
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

between the mind and the body), social roles, and overar- was referred for psychotherapy and vocational rehabilitation.
This document is copyrighted by the American Psychological Association or one of its allied publishers.

ching cultural values. Harvey (2007) has argued that resil- He presented with a history of mild intellectual disability
ience is influenced by individuals’ and communities’ com- acquired secondary to a traumatic brain injury (TBI), sustained
plex and dynamic contexts; as such, resilience in the process at age 15. Before his injury, Anthony was enrolled in a college
of trauma recovery entails negotiation of multiple domains prep high school and was active in athletics and extracurricu-
of functioning within these contexts and is shaped by ac- lars. Anthony lost both his parents and two siblings when he
cessible resources and cultural values and beliefs. and his family were in a car accident. Two older siblings now
serve as his guardians. Clinical discussions indicated that An-
thony was struggling with impulse control that led to difficul-
Applications to Practice, Research, ties at his residence and the sheltered employment program he
and Consultation attended. Early therapeutic work focused on helping Anthony
Practice. Culturally informed clinical and community- share his experience of himself as a man with an acquired
based interventions consider the role of historical and ongoing disability and how his viewpoint of himself had changed.
experiences of trauma and social injustice, as experienced and Because he sustained injuries to his developing executive
narrated by survivors (Brown, 2010). Attending to trauma and skills, he had challenges with flexibility, thinking strategically,
resilience in psychological practice further involves a consid- and impulsivity, including saying inappropriate things to oth-
eration of traumatic exposure that is not currently recognized ers. Anthony shared that he often felt dismayed that he was
as a precipitant to PTSD in existing psychiatric diagnostic now seen as “ugly” and “stupid.” He compared what was
manuals. Specifically, traumatic stress rooted in exposure to different for him across time, focusing on the scar he had
violence based on sexism, racism, xenophobia, deportation because of his neurosurgeries, his inability to ambulate inde-
policies, religious discrimination, poverty, heterosexism, ho- pendently, and his altered growth, because he was notably
mophobia, transphobia, social class discrimination, and shorter than peers. Anthony began to talk more directly about
ableism is a key problem that negatively affects individuals’ what he lost cognitively and emotionally because of the acci-
and communities’ psychological well-being. Psychologists in dent, sharing that he had been a budding wrestler and a good
practice settings can inquire about individuals’ and communi- student before his TBI and that he had many friends then, too.
ties’ experiences with social and political injustice and trauma Anthony stated that he was often reminded of his losses when
and their impact on psychological health and access to appro- he saw perceived neurotypical peers outside of his program
priate care and resources. and residence.
Research. Research is needed on the local definitions As treatment continued, discussions focused on Anthony’s
of resilience, such as religious precepts (Roysircar, 2013), experience of loss and his ability to see the possibility of a life
and political processes of nationalism and patriotism, to that was more layered and optimistic. Regarding his impulsive
provide evidence for the concept of cultural resilience actions, the therapist helped Anthony better understand his
(Clauss-Ehlers, 2008). Research can incorporate samples range of feelings regarding intimacy and sexuality. They took
that represent diverse sociodemographic and developmental into account that he had physical and cognitive differences that
variables. The application of qualitative and quantitative affected how he could express his attraction to someone. One
approaches will present diverse ways to explore relevant important step forward occurred when Anthony was able to
constructs. meet a wider range of peers, both for friendship and for
Consultation. Consultation also encompasses attention potential dating, and to distinguish between an interest in
to secondary traumatic stress and vicarious traumatization, intimacy and sexual desire. Therapy helped Anthony talk about
including that of mental health providers. Systemic factors and better understand his sexual desires and his body and to
of resilience include reductions of disparity in health and learn how to express his feelings in a socially appropriate
psychological care. manner. Anthony worked to recognize himself as not only
 APA MULTICULTURAL GUIDELINES EXECUTIVE SUMMARY 243

someone with a disability but also as a member of a wider Bernal, G., & Domenech Rodríguez, M. M. (Eds.). (2012). Cultural ad-
array of communities. He was supported in mourning the aptations: Tools for evidence-based practice with diverse populations.
http://dx.doi.org/10.1037/13752-000
trauma and losses he experienced and in beginning to view
Bronfenbrenner, U. (1977). Toward an experimental ecology of human
himself as resilient. This led Anthony to seek out new oppor- development. American Psychologist, 32, 513–531. http://dx.doi.org/10
tunities within his vocational program and to open himself up .1037/0003-066X.32.7.513
to the interest that a fellow peer had expressed with regard to Bronfenbrenner, U. (1979). The ecology of human development: Experi-
dating him. ments by nature and design. Cambridge, MA: Harvard University Press.
Brown, L. S. (2010). Feminist therapy. Washington, DC: American Psy-
chological Association.
Conclusion Byng, M. (2017). Transnationalism among second-generation Muslim
Americans: Being and belonging in their transnational social field.
The goal of the 2017 Multicultural Guidelines is to pres- Social Sciences, 6, 131. http://dx.doi.org/10.3390/socsci6040131
ent practice guidelines to help the practitioner, educator, Chiriboga, D. A., & Hernandez, M. (2015). Multicultural competence in
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researcher, and consultant strive to identify, understand, and geropsychology. In P. A. Lichtenberg & B. T. Mast (Eds.), APA hand-
This document is copyrighted by the American Psychological Association or one of its allied publishers.

book of clinical geropsychology (pp. 379 – 419). Washington, DC:

respond to multicultural content in a helpful, professional
American Psychological Association.
way. The five layers of the Layered Ecological Model of the Chiu, C. Y., & Chen, J. (2004). Symbols and interactions: Application of
Multicultural Guidelines— bidirectional model of self- the CCC model to culture, language, and social identity. In S. H. Ng,
definition and relationships; community, school, and family C. N. Candlin, & C. Y. Chiu (Eds.), Language matters: Communication,
context; institutional impact on engagement; domestic and culture, and identity (pp. 155–182). Hong Kong: City University of
Hong Kong Press.
international climate; and outcomes—present an ecological
Cho, S., Crenshaw, K. W., & McCall, L. (2013). Toward a field of
framework from which psychologists can consider and ap- intersectionality studies: Theory, applications, and praxis. Signs: Jour-
ply the Multicultural Guidelines. nal of Women in Culture and Society, 38, 785– 810. http://dx.doi.org/10
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Clauss-Ehlers, C. S. (2004). Re-inventing resilience: A model of
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1041–1047. Accepted August 17, 2018 䡲