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Culturally competent research
Clinical Psychology Review, Vol. 19, No. 1, pp. 45–55, 1999 Copyright © 1999 Elsevier Science Ltd Printed in the USA. All rights reserved 0272-7358/99/$–see front matter
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CULTURALLY COMPETENT RESEARCH: AN ETHICAL PERSPECTIVE Eleanor F. Gil and Sheila Bob Pacific University
ABSTRACT. This article addresses the perspective of the Ethical Principles and Guidelines for Providers regarding issues affecting research with ethnic minority populations. Issues such as failure to report or give informed consent to research participants, lack of diversity among researchers, inappropriate study of ethnic minority populations, and culturally insensitive assessment instruments are discussed. Examples of recommended responsibilities and criteria for culturally competent research are provided, including increased involvement of minorities in research, both as investigators and concerned citizens. In sum, the recommendations address the larger problem of failure to acknowledge people in their cultural context. Finally, implications for the Ethical Principles and Guidelines for Providers are considered. © 1999 Elsevier Science Ltd
THE AMERICAN PSYCHOLOGICAL ASSOCIATION (APA) has developed two documents containing ethical guidelines for offering service to ethnic minority populations in a culturally sound manner. These are the Ethical Principles of Psychologists and Code of Conduct (hereafter referred to as Ethical Principles; American Psychological Association, 1992) and the Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations (hereafter referred to as Guidelines for Providers) developed by the American Psychological Association’s Board of Ethnic Minority Affairs Task Force on the Delivery of Services to Ethnic Minority Populations (1990). Although these documents address issues of concern to ethnic minority populations, each area of professional competence may be vulnerable to a specific set of ethical dilemmas within the framework of issues that impact minorities. For this reason, it may be particularly informative to examine, from an ethical perspective, those concerns related to research with ethnic minority populations. Our article addresses the general perspective of the Ethical Principles and Guidelines for Providers about issues impeding cultural sensitivity in psychology. An examination of current problems in research with ethnic minority populations is followed by a discussion of how they can be addressed in order to conduct culturally sound re-
Correspondence should be addressed to Eleanor F. Gil, Pacific University, School of Professional Psychology, 2004 Pacific Avenue, Forest Grove, OR 97116-2328.
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search. Finally, implications for the Ethical Principles and Guidelines for Providers are considered.
WHAT DO THE APA DOCUMENTS SAY ABOUT DIVERSE GROUPS?
Ethical Principles The current code of ethics (American Psychological Association, 1992) has strengthened regulations pertaining to human differences, respecting others, and nondiscrimination in Standards 1.08, 1.09, and 1.10, respectively. Standard 1.08 requires psychologists to ensure competent services by obtaining appropriate training, supervision, experience, and consultation when a human-difference issue is significantly affecting their work. If competent services cannot be offered, then an appropriate referral must be made in a timely manner (Canter, Bennett, Jones, & Nagy, 1994). Standard 1.09 states that, “in their work-related activities, psychologists respect the rights of others to hold values, attitudes, and opinions that differ from their own” (American Psychological Association, 1992). Finally, Standard 1.10 allows appropriate scientific and professional differentiation, but prohibits “unfair discrimination” based on variables such as gender, race, ethnicity, religion, sexual orientation, or any basis proscribed by law (Canter et al., 1994). These revised regulations appear to reflect sensitivity to the needs and treatment of ethnic minority populations and other diverse groups.
Guidelines for Providers Although these guidelines are not enforceable, they were developed to “enlighten all areas of service delivery” and to provide guidance and “suggestions to psychologists in working with ethnic, linguistic, and culturally diverse populations” (American Psychological Association’s Board of Ethnic Minority Affairs Task Force on the Delivery of Services to Ethnic Minority Populations, 1990, p. 2). These guidelines include, but are not limited to, suggestions that psychologists engage in the following activities: (a) educate clients regarding the processes of psychological intervention; (b) increase awareness of research and practice issues impacting ethnic minority populations; (c) incorporate ethnicity and culture in their understanding of psychological processes; (d) respect roles and beliefs within the client’s culture; (e) consider the influence of negative environmental and other factors in problem assessment and intervention design; and (f) attend to and work to eliminate biases, prejudices, and discriminatory practices (Board of Ethnic Minority Affairs). These guidelines are an attempt on the part of APA to increase psychologist’s awareness and recognition of issues affecting ethnic, linguistic, and culturally diverse populations, as well as to inform psychologists of steps that should be taken to provide culturally sound services.
IMPLICATIONS OF THE ETHICAL PRINCIPLES AND GUIDELINES FOR PROVIDERS It is apparent that APA has expended great effort addressing concerns related to diverse populations. Standards 1.08, 1.09, and 1.10 address such concerns, and the Guidelines for Providers offer extensive suggestions on how to approach relevant issues in a culturally sensitive manner. In this context, it may seem unreasonable to
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question the overall message the APA documents provide as to issues of cultural sensitivity. Despite APA’s documented concern for cultural sensitivity, some psychologists have expressed discomfort with the current code of ethics in its approach to addressing issues relevant to diverse groups. Payton (1994) pointed out that “in at least three places, the reader is cautioned that the code applies only to psychologist’s work-related activities” (p. 317). This statement combined with a change in the presentation of the Preamble over the years from “the worth of a profession is measured by its contribution to the welfare of man” (American Psychological Association, 1953, p. 1), to the current “psychologists work to develop a valid and reliable body of scientific knowledge based on research” (American Psychological Association, 1992, p. 1599) has, in Payton’s opinion, downgraded the respect for worth of the individual and the pledge to protect fundamental human rights. In her critique of the 1992 revised Ethical Principles, Payton (1994) expressed concern that added modifiers “render the edicts meaningless” (p. 319) and no longer have the “quality of an obligatory sense of duty to carry out certain actions” (p. 319). She felt that this did not favor diverse groups because their growth within the organization derives from their appeals for APA to endorse “socially responsible behavior from the membership, buttressed by the profession’s articulated humanitarian concerns” (Payton, 1994, p. 319). Payton (1994) thus asserted that a moral tradition as the primary concern of basic human rights has been abandoned by psychologists and that this could result in lack of advancement of diverse groups within the APA. The current code of ethics has been criticized as ambiguous and vague (Bersoff, 1994; Deaner, 1997; Sieber, 1994; Vasquez, 1994). Sonne (1994) described such lack of clarity and guidance as a possible obstacle for the ethical psychologist and as an aid for the psychologist wanting to rationalize unethical behavior. From this perspective, it can be argued that the new “diluted” presentation of the Ethical Principles may diminish the effects of positive efforts on the part of APA to improve interactions with diverse groups in all realms of psychology, as is attempted in the Guidelines for Providers. It is clear that, despite obvious efforts on the part of APA to address issues in psychology related to ethnic minorities and other diverse populations, psychologists such as Payton express discomfort resulting from the current presentation of the Ethical Principles and the implications for ethnic, linguistic, and culturally diverse groups.
RESEARCH CONCERNS IMPACTING ETHNIC MINORITY GROUPS Despite attention given by the Ethical Principles to concerns with ethnic minorities and other diverse populations as well as to research issues in psychology, nowhere are these two areas brought together into one section devoted specifically to research issues with diverse groups. This statement is not meant to imply a necessity for APA to offer an exhaustive list of issues relevant to ethnic minority populations, especially when certain ethical considerations remain stable across service areas. However, there are some issues that are particularly relevant in the context of research for ethnic minority groups that may improve the application of the Ethical Principles and Guidelines for Providers. Furthermore, racial-ethnic minorities suffer disproportionately from a number of psychosocial problems, including substance abuse, family disruption, unemployment, high dropout rates, and other problems that can only be overcome through the development and implementation of programs resulting from col-
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laborative university- and community-based research efforts (Casas & Thompson, 1991). For this reason, it is especially worthwhile to focus on research issues impacting ethnic-racial minorities as the subject of this review.
Failure to Report A feature of research conducted on racial-ethnic minorities is that it has tended to be very political, often antiminority in culture, and far from humanistic in orientation (Sue, 1990). The Tuskegee experiment is a historical example of an antiminority, inhumane research study that also demonstrates an extreme in one of the ethical concerns related to research with diverse groups: failure to report. In this experiment, researchers observed a disorder without reporting it to the research participants. A brief description of this event is described next. The natural course of untreated syphilis was studied by the U.S. Public Health Service from 1932 to 1972 in 412 African-American men in Tuskegee, Alabama. The participants were poor, illiterate, and did not know they had syphilis. The Tuskegee experiment did not result in any new knowledge or new treatment for syphilis, although the study continued for 40 years. The unethical, poorly designed project, with no clear scientific purpose, was made public and halted in 1972. (Scott-Jones, 1994, p. 98)
The devastation of the Tuskegee experiment led the U.S. Senate to hold hearings on research ethics in 1973. As a result, Public Law 93-348, the National Research Act, was passed in 1974 (Bowman, 1991). This act requires establishment of institutional review boards (IRBs) at all major research institutions. The National Research Act also calls for creation of a national commission on the protection of human participants (Scott-Jones, 1994). In light of the current, widely accepted ethical standards, obviously no project resembling the Tuskegee experiment today would be funded by any governmental agency or supported by any IRB (Scott-Jones, 1994). Failure to report may result from a researcher’s desire to examine a problem as it exists and progresses without intervention (Scott-Jones, 1994). Although this would no longer be approved in an extreme situation such as the Tuskegee experiment, it is fostered on one level by the no-treatment control groups in intervention research. Many low-income minority children participate in this standard research paradigm, which requires that a randomly selected group of children receive a presumed beneficial treatment and another randomly selected, and therefore equally needy group, be assessed without benefit of treatment (Scott-Jones, 1994). The ethical dilemma in the treatment-control model pits “good science” against “participant welfare” (Koocher & Keith-Spiegel, 1990). One view holds that research not directly benefiting its child participants is a violation of respect for humans, making a study with low-income children in no-treatment control groups unethical. The other view asserts that research should be allowed if it involves risks no greater than those children already encounter in everyday life; from this perspective, observing and assessing low-income children in control groups without intervention is ethical because it benefits children in general (Scott-Jones, 1994). This situation “allows for the interpretation that greater risk is acceptable in research with children exposed to danger in their everyday lives than in research with children who live in relatively safe environments” (Scott-Jones, 1994, p. 99). Failure to report to control group participants in the treatment-control model appears to support the prevention of harm while ignoring the provision of benefits.
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From the perspective of research implications for diverse groups, a strong argument can be made that, given the overwhelming sociopsychological problems that plague minority communities, this practice should no longer be considered ethical (Casas & Thompson, 1991). There are several ways in which the treatment-control dilemma can be altered so that it addresses intervention concerns in a manner that is beneficial to all participants. One suggestion is for the control group to receive the treatment after the treatment-control comparison is made; however, this is problematic where longitudinal designs are concerned (Scott-Jones, 1994). It is possible in longitudinal research with a control group to do a midexperiment check, where if the treatment group is showing significant improvement over the control group, then the latter can begin receiving the treatment as well (Fisher & Rosendahl, 1990). Other scientific and ethical alternatives include comparing possible beneficial treatments to each other without a notreatment control, intraindividual treatment, or comparing results of treatment groups to a carefully chosen established standard (Scott-Jones, 1994). The goal is to move away from a research design that excludes a group in need of services from experiencing the benefits of treatment.
Lack of Diversity Among Researchers In conducting research, it is advantageous for members of the groups being studied to have a central role in the research process. It is equally important for research to incorporate the perspective of the study population (Bowman, 1991). Given the lack of racial-ethnic minority faculty and staff on most campuses and research settings, however, it is difficult for these needs to be met. Recent statistics show that, in the 1995– 1996 academic year, 4% of faculty in U.S. graduate departments in psychology were African American, and 2% were Hispanic. Furthermore, these percentages reflect only a minimal increase over the past 15 years (American Psychological Association and Council of Graduate Departments of Psychology, 1997). The study of racial and ethnic issues in the social sciences has remained deeply grounded in societal folk beliefs about racial and ethnic differences (Scott-Jones, 1994). This may result in research that does not target the real needs of the minority community being studied. Presence of minorities as researchers increases the likelihood that reporting and referring, as well as other ethical issues, will be managed appropriately (Scott-Jones, 1994). Additionally, researchers should be actively involved in the recruitment and retention of racial-ethnic minority undergraduate and graduate students whom they can use as co-researchers and research assistants (Casas & Thompson, 1991). Minority student involvement can result in the development of better insights about the research process as well as increased motivation for involvement in other projects that may benefit minority communities. This suggestion is not meant to imply that White researchers should not study diverse groups. What is being suggested, however, is the view that racial-ethnic bias is inherently present. For example, Abramowitz and Murray (1983) concluded that ethnic minority and White researchers who examine the same data usually come up with completely opposite conclusions that are basically drawn along ethnic lines. Furthermore, “we each have our own way of interpreting data based on the cultural lenses through which we view the world, and we must guard against this bias when we as researchers, regardless of our ethnicity, study cross-cultural issues” (Atkinson, 1993, p. 220).
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Again, guarding against this bias does not mean that only ethnic minority researchers should conduct studies with ethnic minority groups. Each researcher, regardless of his or her background, has an important contribution to make. What is necessary, however, is to minimize the effects of researcher bias; one way in which this can be done is through the development of ethnically diverse research teams, with at least one member of each ethnic group sampled also represented on the research team (Atkinson, 1993). Additionally, IRBs, research funding agencies, and journal editorial boards need to be ethnically diverse so that proposals and manuscripts can be reviewed by panels that also reflect the diversity of the research population (Atkinson, 1993). By including at least one researcher on the investigatory team from the minority group targeted for study, the possibility of stereotyped views or distorted perception of ethical issues decreases. Given the growing ethnic diversity in this country and the disproportionate problems affecting ethnic minority communities, a lack of diversity among researchers may be perceived by some as an unethical practice.
Ethnic Minority Populations Are Inappropriately Studied and Understudied Negative stereotypes and lack of perspective on the real needs of minority communities may often lead to problem-focused research on ethnic minority populations. In addition, greater involvement of public agencies in offering services to ethnic-racial minorities results in these populations being more accessible to researchers studying psychological and social problems (Scott-Jones, 1994). For example, recruitment of African American children in intervention studies of children in poverty is not scientifically sound given the diversity of children and families living in poverty. Research on low-income African American children will not necessarily be generalizable to all children living in poverty (Scott-Jones, 1994). Ethnic minorities are constantly represented in studies focusing on psychological and social problems. Although it is true that there are excessive social and psychological problems existing in minority communities, minority and low-income populations are not likely to be recruited for research on normal developmental processes (ScottJones, 1994). This only exacerbates existing negative stereotypes, creating distance between the perspectives of researchers on issues impacting minorities and actual problems based on the reality and needs of the minority communities. Strategies for preventing inadequate study of ethnic-racial minority groups include involvement of ethnic minority investigators on the research team. Miranda (1996) emphasized the necessity for collaboration between ethnic minority and ethnic majority researchers in order to learn truly for whom and under what circumstances treatments work. Another strategy, suggested by Casas and Thompson (1991), is to meet with the targeted minority community to identify and prioritize research projects that the community members feel are noteworthy. They also suggested that researchers consider forming community-based advisory committees that continue to monitor the research and its success in meeting the real needs of the community. Inclusion of ethnic minorities in research, both as concerned citizens and as investigators, will ensure greater relevance in problems addressed with minority communities via research.
Culturally Insensitive Assessment Instruments Typically, assessment instruments have been designed by Europeans or North Americans and embody a Eurocentric world view and derivative psychometric technology
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(Dana, 1996). The term emic describes categories that are culture specific or totally isolated from other cultures. In contrast, etic refers to culture-general, or universal, categories (Pedersen, 1991). Many tests are emic measures designed for European Americans but have been assumed to be etic measures or pseudoetics because the equivalence of measures for use with different cultural groups has not been demonstrated (Dana, 1996). This problem often results in research processes that force minority groups to fit their experiences to rigid instruments developed with White male populations (Hall, 1993). Utilizing pseudoetic structures with multicultural populations feeds a process that results in many negative consequences for these communities. Initial use of these instruments already places minority groups in a position of being judged psychosocially in comparison to European American normative standards. This comparison falsely minimizes group differences, often culminating in stereotypes based on inappropriate interpretations from a European American perspective. These new “findings” in the form of stereotypes may inspire new research, and a new cycle begins. This assessment dilemma has continuous negative mental health consequences for visible racial and ethnic groups in the United States (Dana, 1996). A culture-specific or emic perspective requires assessors to become culturally competent. Cultural sensitivity, in this context, refers to the: ability to balance a consideration of universal norms, specific group norms, and individual norms in (a) differentiating between normal and abnormal behavior, (b) considering etiological factors, and (c) implementing appropriate interventions. . . . it is critical that clinicians vigorously assess what the client’s view is in regard to the supposed culturally normative behavior. . . . Cultural sensitivity then involves balancing different norms and constantly testing alternative hypotheses. (Lopez et al., 1989, p. 370)
The Guidelines for Providers makes the following, more specific suggestion as to how to conduct culturally appropriate research and assessment: Psychologists consider the validity of a given instrument or procedure and interpret resulting data, keeping in mind the cultural and linguistic characteristics of the person being assessed. Psychologists are aware of the test’s reference population and possible limitations of such instruments with other populations. (American Psychological Association’s Board of Ethnic Minority Affairs Task Force on the Delivery of Services to Ethnic Minority Populations, 1990, p. 2, 2d)
The first step in working toward culturally competent research and assessment is to increase awareness. Such awareness may result in researchers and clinicians seeking alternatives to the use of culturally inappropriate assessment tools. One solution is assessment of the single case using multiple methods which merges the approaches of the scientist and the practioner. Single-case procedures are part of a more personalized approach, serving as an antidote to an increasing technologization and depersonalization of the assessment process (Dana, 1996). In this approach, the assessor and client collaborate to develop an individualized assessment process or use methods that establish meaning by restoring a life context to assessment (Dana, 1996). In this approach, the data not only increase one’s understanding of the problem but also allow the client to receive and benefit from treatment. The effectiveness of this methodology provides a foundation for the true science of human behavior, with a focus on the paramount importance of the individual (Barlow & Hersen, 1984). Howard (1991) suggested that introspective narratives or storytelling can offer a credible de-
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piction of an individual’s subjective culture. The life story constitutes personal identity, with class, ethnicity, culture, and race providing the relevant roles in the story. Brislin (1993) also proposed that culturally competent assessment requires translations to be checked for equivalency in meaning and measurement. Cross-cultural validity requires that the existence of a metric measure of test constructs is verified. Furthermore, even when constructs do exist in other cultures, it is necessary to determine whether or not the meaning and subjective experience of these constructs are equivalent cross-culturally (Dana, 1996). Culturally sensitive research should include selection of tests on the basis of cultural orientation information. Gathering information on cultural orientation status should occur prior to the assessment process in order to determine both service delivery style and test content. Selection of tests with minority populations should account for uneven and individualized incorporation of behaviors and values from two cultures (Dana, 1996). Assessment tools should acknowledge participants as cultural beings; doing so will provide results that are more relevant to the needs of the populations being studied. This section has discussed only some of the many research concerns impacting ethnic minority groups: failure to report, lack of diversity among researchers, inappropriate study of ethnic minorities, and culturally insensitive assessment instruments. These concerns are a fair representation of the larger problem regarding research with ethnic minority populations: failure to acknowledge people as cultural beings and therefore not recognizing the implications this approach carries for ethnic-racial minority populations. Table 1 provides a summary of recommended responsibilities and criteria for cultural competence in research.
TABLE 1. Examples of Recommended Responsibilities and Criteria for Cultural Competence in Research Area of Concern Failure to report or inform
Diversity among researchers
Appropriate study of ethnic minority populations
Assessment
Criteria for Competence 1. Compare possible beneficial treatments to each other without a control group (Scott-Jones, 1994). 2. Give the potentially beneficial treatment to the control group if the treatment appears to be effective (Scott-Jones, 1994). 1. Recruitment and retention of racial minority graduate students to increase their involvement as co-researchers (Casas & Thompson, 1991). 2. Development of ethnically diverse research teams, with members of each ethnic group sampled represented on the team (Atkinson, 1993). 1. Meet with the targeted minority community to identify and prioritize research projects the community finds significant (Casas & Thompson, 1991). 2. Develop community-based advisory committees to monitor the research and its relevance to the needs of the community (Casas & Thompson, 1991). 1. Translations should be checked for equivalency in meaning and measurement (Brislin, 1993). 2. Select tests based on cultural orientation information (Dana, 1996).
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HOW DO THE APA DOCUMENTS IMPACT RESEARCH CONCERNS WITH MINORITY GROUPS? Cultural competence is a major ingredient in responsible mental health services, including research, for multicultural populations. It is evident by examining the Ethical Principles and Guidelines for Providers that APA is responding to the growing need for appropriate services that address the diverse and changing culture of this country. However, the question posed about APA’s acknowledgment of cross-cultural issues did not focus on whether or not these concerns were addressed but rather on the underlying philosophical premises and approach to these concerns. One concern raised over the Ethical Principles is the focus on the prevention of harm while ignoring the provision of benefits as this applies to minority communities (Casas & Thompson, 1991). Given the major sociopsychological problems plaguing minority communities, there should be a greater or at least equal emphasis on the benefits that can be provided to these groups. Earlier in this review, Payton’s (1994) view was expressed about APA’s movement away from the profession ideal for respect of the worth of the individual and protection of fundamental human rights. A different view for APA’s approach to cross-cultural concerns implies that the Ethical Principles fail to address minority groups explicitly but do so implicitly via a universal humanistic perspective that emphasizes the worth of all individuals (Casas & Thompson, 1991). This argument seems sound, especially in light of Ethical Principle 1.10 (Nondiscrimination), stated as follows: “In their work-related activities, psychologists do not engage in unfair discrimination based on age, gender, race, ethnicity, national origin, religion, sexual orientation, disability, socioeconomic status, or any basis proscribed by law” (Canter et al., 1994, p. 40). However, in spite of this seemingly universal concern for all people in Principle 1.10, one might come away with the sense that: care was taken to ensure that no one could complain about having been excluded. . . . The 1992 revision appears to be concerned with offering protection to psychologists first and foremost. . . . Removal of the many instances of exceptions to the rule would make the code more enforceable and more reflective of our discipline, which at one time was dedicated to the promotion of human welfare. (Payton, 1994, p. 320)
From either perspective, however, the rights of minority populations seem to be underemphasized. If the Ethical Principles are focusing on the rights of all individuals, there are two concerns. The first is that, given the context of discrimination that exists in our society, there may need to be more emphasis on this issue. Second, terminology such as “in their work-related activities” implies that it is permissible to not care about the fundamental rights of all outside of one’s role as a psychologist. From Payton’s (1994) perspective, lumping all groups together to avoid excluding any one community easily moves away from respecting the worth of the individual, especially the individual with special needs. This discussion is not meant to detract from APA’s efforts to address the special concerns of diverse groups. In fact, the Guidelines for Providers offers an impressive set of suggestions for culturally appropriate service delivery. However, although very valuable, these Guidelines may be underemphasized in the context of their aspirational (as opposed to enforceable) nature and their role of providing suggestions to service providers. Combined with the perspective that the Ethical Principles have glossed over the needs of minority populations, APA may be criticized despite obvious efforts
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to address the many ethical concerns impacting minority populations in a variety of psychological service contexts.
SUMMARY There has long been a need for culturally sensitive services, including those related to research endeavors. The APA has responded to this demand by addressing research concerns in both the Ethical Principles and the Guidelines for Providers. Although these steps are commendable and necessary, there may be additional ways in which to address these concerns. Apparently problematic are terms such as reasonable, feasible, and with due concern for, which may suggest rather than enforce cultural sensitivity. Such terminology may also de-emphasize the efforts that APA has put forth in this regard. In terms of conducting research ethically with minority populations, it requires a concern for the well-being of the individual participants. Without initial attempts to understand the special concerns related to ethnic minority participants, researchers cannot know what assessment and methodology is in the best interest for the group being studied. Services that are not in the best interest of the client or participant do not respect the worth and dignity of that person. This is questionable, and it is from an ethical perspective that problems related to cultural sensitivity should be initially addressed. Without the basic foundation of concern for the worth and dignity of others, culturally sensitive practices cannot bring about change in any realm of psychological services. Our article has explored some of the ethical considerations in conducting research with ethnic minority populations, specifically in relation to the following concerns: failure to report or inform research participants, lack of diversity among researchers, inappropriate study and understudy of minority populations, and culturally insensitive assessment instruments. Examination of these concerns has been useful in providing examples of recommended responsibilities and criteria for culturally competent research. These responsibilities address the importance of involving minorities in research projects, both as investigators and as concerned citizens. Other responsibilities include selection of test instruments based on cultural orientation information and comparison of possible beneficial treatments without a no-treatment control group. The overall theme for all of the recommended criteria is related to the broader problem regarding research with ethnic minority populations: failure to acknowledge people as cultural beings and therefore not recognizing the implications this approach carries for ethnic-racial minority populations. Continued exploration of ethical considerations relevant to the needs of ethnic minority populations can increase awareness and competence among researchers as well as psychologists working in other areas of service. REFERENCES Abramowitz, S. I., & Murray, J. (1983). Race effects in psychotherapy. In J. Murray & P. R. Abramson (Eds.), Bias in psychotherapy (pp. 215–255). New York: Praeger. American Psychological Association. (1953). Ethical standards of psychologists: A summary of ethical principles. Washington, DC: Author. American Psychological Association. (1992). Ethical principles of psychologists and code of conduct. American Psychologist, 47, 1597–1611. American Psychological Association and Council of Graduate Departments of Psychology. (1997, December
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11). Surveys of Graduate Departments of Psychology, 1981–82 through 1995–96. (Available from the APA Research Office, 750 First St., NE, Washington, DC, 20002-4242) American Psychological Association’s Board of Ethnic Minority Affairs Task Force on the Delivery of Services to Ethnic Minority Populations. (1990). Guidelines for providers of psychological services to ethnic, linguistic, and culturally diverse populations. Washington, DC: American Psychological Association. Atkinson, D. R. (1993). Who speaks for cross-cultural counseling research? The Counseling Psychologist, 21(2), 218–224. Barlow, D. H., & Hersen, M. (1984). Single-case experimental designs: Strategies for studying behavior change (2nd ed.). Needham Heights, MA: Allyn & Bacon. Bersoff, D. N. (1994). Explicit ambiguity: The 1992 ethics code as an oxymoron. Professional Psychology: Research and Practice, 25(4), 382–387. Bowman, P. J. (1991). Race, class, and ethics in research: Belmont principles to functional relevance. In R. L. Jones (Ed.), Black psychology (3rd ed., pp. 747–766). Berkeley, CA: Cobb & Henry. Brislin, R. W. (1993). Understanding culture’s influence on behavior. New York:Harcourt Brace Jovanovich. Canter, M. B., Bennett, B. E., Jones, S. E., & Nagy, T. F. (1994). Ethics for psychologists: A commentary on the APA ethics code. Washington, DC: American Psychological Association. Casas, J. M., & Thompson, C. E. (1991). Ethical principles and standards: A racial-ethnic minority research perspective. Counseling and Values, 35, 186–195. Dana, R. H. (1996). Culturally competent assessment practice in the United States. Journal of Personality Assessment, 66(3), 472–487. Deaner, S. L. (1997). The next step: Psychology graduate students and ethics. The Behavior Therapist, 20(8), 143–145. Fisher, C. B., & Rosendahl, S. A. (1990). Psychological risks and remedies of research participation. In C. B. Fisher & W. W. Tryon (Eds.), Ethics in applied developmental psychology: Emerging issues in an emerging field (pp. 43–59). Norwood, NJ: Ablex. Hall, J. M. (1993). What really works? A case analysis and discussion of confrontational intervention for substance abuse in marginalized women. Archives of Psychiatric Nursing, 7(6), 322–327. Howard, G. S. (1991). Culture tales: A narrative approach to thinking, cross-cultural psychology, and psychotherapy. American Psychologist, 46, 187–197. Koocher, G. P., & Keith-Spiegel, P. C. (1990). Children, ethics, and the law. Lincoln: University of Nebraska Press. Lopez, S. R., Grover, K. P., Holland, D., Johnson, M. J., Kain, C. D., Kanel, K., Mellins, S. A., & Rhyne, M. C. (1989). Development of culturally sensitive psychotherapists. Professional Psychology: Research and Practice, 20, 369–376. Miranda, J. (1996). Introduction to the special section on recruiting and retaining minorities in psychotherapy research. Journal of Consulting and Clinical Psychology, 64(5), 848–850. Payton, C. R. (1994). Implications of the 1992 ethics code for diverse groups. Professional Psychology: Research and Practice, 25(4), 317–320. Pedersen, P. B. (1991). Multiculturalism as a generic approach to counseling. Journal of Counseling and Development, 70, 6–12. Scott-Jones, D. (1994). Ethical issues in reporting and referring in research with low-income minority children. Ethics and Behavior, 4(2), 97–108. Sieber, J. E. (1994). Will the new code help researchers to be more ethical? Professional Psychology: Research and Practice, 25(4), 369–375. Sonne, J. L. (1994). Multiple relationships: Does the new ethics code answer the right questions? Professional Psychology: Research and Practice, 25, 336–343. Sue, D. W. (1990). Counseling the culturally different: Theory and practice. New York: Wiley. Vasquez, M. J. T. (1994). Implications of the 1992 ethics code for the practice of individual psychotherapy. Professional Psychology: Research and Practice, 25(4), 321–328.
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CULTURALLY COMPETENT RESEARCH: AN ETHICAL PERSPECTIVE Eleanor F. Gil and Sheila Bob Pacific University
ABSTRACT. This article addresses the perspective of the Ethical Principles and Guidelines for Providers regarding issues affecting research with ethnic minority populations. Issues such as failure to report or give informed consent to research participants, lack of diversity among researchers, inappropriate study of ethnic minority populations, and culturally insensitive assessment instruments are discussed. Examples of recommended responsibilities and criteria for culturally competent research are provided, including increased involvement of minorities in research, both as investigators and concerned citizens. In sum, the recommendations address the larger problem of failure to acknowledge people in their cultural context. Finally, implications for the Ethical Principles and Guidelines for Providers are considered. © 1999 Elsevier Science Ltd
THE AMERICAN PSYCHOLOGICAL ASSOCIATION (APA) has developed two documents containing ethical guidelines for offering service to ethnic minority populations in a culturally sound manner. These are the Ethical Principles of Psychologists and Code of Conduct (hereafter referred to as Ethical Principles; American Psychological Association, 1992) and the Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations (hereafter referred to as Guidelines for Providers) developed by the American Psychological Association’s Board of Ethnic Minority Affairs Task Force on the Delivery of Services to Ethnic Minority Populations (1990). Although these documents address issues of concern to ethnic minority populations, each area of professional competence may be vulnerable to a specific set of ethical dilemmas within the framework of issues that impact minorities. For this reason, it may be particularly informative to examine, from an ethical perspective, those concerns related to research with ethnic minority populations. Our article addresses the general perspective of the Ethical Principles and Guidelines for Providers about issues impeding cultural sensitivity in psychology. An examination of current problems in research with ethnic minority populations is followed by a discussion of how they can be addressed in order to conduct culturally sound re-
Correspondence should be addressed to Eleanor F. Gil, Pacific University, School of Professional Psychology, 2004 Pacific Avenue, Forest Grove, OR 97116-2328.
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search. Finally, implications for the Ethical Principles and Guidelines for Providers are considered.
WHAT DO THE APA DOCUMENTS SAY ABOUT DIVERSE GROUPS?
Ethical Principles The current code of ethics (American Psychological Association, 1992) has strengthened regulations pertaining to human differences, respecting others, and nondiscrimination in Standards 1.08, 1.09, and 1.10, respectively. Standard 1.08 requires psychologists to ensure competent services by obtaining appropriate training, supervision, experience, and consultation when a human-difference issue is significantly affecting their work. If competent services cannot be offered, then an appropriate referral must be made in a timely manner (Canter, Bennett, Jones, & Nagy, 1994). Standard 1.09 states that, “in their work-related activities, psychologists respect the rights of others to hold values, attitudes, and opinions that differ from their own” (American Psychological Association, 1992). Finally, Standard 1.10 allows appropriate scientific and professional differentiation, but prohibits “unfair discrimination” based on variables such as gender, race, ethnicity, religion, sexual orientation, or any basis proscribed by law (Canter et al., 1994). These revised regulations appear to reflect sensitivity to the needs and treatment of ethnic minority populations and other diverse groups.
Guidelines for Providers Although these guidelines are not enforceable, they were developed to “enlighten all areas of service delivery” and to provide guidance and “suggestions to psychologists in working with ethnic, linguistic, and culturally diverse populations” (American Psychological Association’s Board of Ethnic Minority Affairs Task Force on the Delivery of Services to Ethnic Minority Populations, 1990, p. 2). These guidelines include, but are not limited to, suggestions that psychologists engage in the following activities: (a) educate clients regarding the processes of psychological intervention; (b) increase awareness of research and practice issues impacting ethnic minority populations; (c) incorporate ethnicity and culture in their understanding of psychological processes; (d) respect roles and beliefs within the client’s culture; (e) consider the influence of negative environmental and other factors in problem assessment and intervention design; and (f) attend to and work to eliminate biases, prejudices, and discriminatory practices (Board of Ethnic Minority Affairs). These guidelines are an attempt on the part of APA to increase psychologist’s awareness and recognition of issues affecting ethnic, linguistic, and culturally diverse populations, as well as to inform psychologists of steps that should be taken to provide culturally sound services.
IMPLICATIONS OF THE ETHICAL PRINCIPLES AND GUIDELINES FOR PROVIDERS It is apparent that APA has expended great effort addressing concerns related to diverse populations. Standards 1.08, 1.09, and 1.10 address such concerns, and the Guidelines for Providers offer extensive suggestions on how to approach relevant issues in a culturally sensitive manner. In this context, it may seem unreasonable to
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question the overall message the APA documents provide as to issues of cultural sensitivity. Despite APA’s documented concern for cultural sensitivity, some psychologists have expressed discomfort with the current code of ethics in its approach to addressing issues relevant to diverse groups. Payton (1994) pointed out that “in at least three places, the reader is cautioned that the code applies only to psychologist’s work-related activities” (p. 317). This statement combined with a change in the presentation of the Preamble over the years from “the worth of a profession is measured by its contribution to the welfare of man” (American Psychological Association, 1953, p. 1), to the current “psychologists work to develop a valid and reliable body of scientific knowledge based on research” (American Psychological Association, 1992, p. 1599) has, in Payton’s opinion, downgraded the respect for worth of the individual and the pledge to protect fundamental human rights. In her critique of the 1992 revised Ethical Principles, Payton (1994) expressed concern that added modifiers “render the edicts meaningless” (p. 319) and no longer have the “quality of an obligatory sense of duty to carry out certain actions” (p. 319). She felt that this did not favor diverse groups because their growth within the organization derives from their appeals for APA to endorse “socially responsible behavior from the membership, buttressed by the profession’s articulated humanitarian concerns” (Payton, 1994, p. 319). Payton (1994) thus asserted that a moral tradition as the primary concern of basic human rights has been abandoned by psychologists and that this could result in lack of advancement of diverse groups within the APA. The current code of ethics has been criticized as ambiguous and vague (Bersoff, 1994; Deaner, 1997; Sieber, 1994; Vasquez, 1994). Sonne (1994) described such lack of clarity and guidance as a possible obstacle for the ethical psychologist and as an aid for the psychologist wanting to rationalize unethical behavior. From this perspective, it can be argued that the new “diluted” presentation of the Ethical Principles may diminish the effects of positive efforts on the part of APA to improve interactions with diverse groups in all realms of psychology, as is attempted in the Guidelines for Providers. It is clear that, despite obvious efforts on the part of APA to address issues in psychology related to ethnic minorities and other diverse populations, psychologists such as Payton express discomfort resulting from the current presentation of the Ethical Principles and the implications for ethnic, linguistic, and culturally diverse groups.
RESEARCH CONCERNS IMPACTING ETHNIC MINORITY GROUPS Despite attention given by the Ethical Principles to concerns with ethnic minorities and other diverse populations as well as to research issues in psychology, nowhere are these two areas brought together into one section devoted specifically to research issues with diverse groups. This statement is not meant to imply a necessity for APA to offer an exhaustive list of issues relevant to ethnic minority populations, especially when certain ethical considerations remain stable across service areas. However, there are some issues that are particularly relevant in the context of research for ethnic minority groups that may improve the application of the Ethical Principles and Guidelines for Providers. Furthermore, racial-ethnic minorities suffer disproportionately from a number of psychosocial problems, including substance abuse, family disruption, unemployment, high dropout rates, and other problems that can only be overcome through the development and implementation of programs resulting from col-
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laborative university- and community-based research efforts (Casas & Thompson, 1991). For this reason, it is especially worthwhile to focus on research issues impacting ethnic-racial minorities as the subject of this review.
Failure to Report A feature of research conducted on racial-ethnic minorities is that it has tended to be very political, often antiminority in culture, and far from humanistic in orientation (Sue, 1990). The Tuskegee experiment is a historical example of an antiminority, inhumane research study that also demonstrates an extreme in one of the ethical concerns related to research with diverse groups: failure to report. In this experiment, researchers observed a disorder without reporting it to the research participants. A brief description of this event is described next. The natural course of untreated syphilis was studied by the U.S. Public Health Service from 1932 to 1972 in 412 African-American men in Tuskegee, Alabama. The participants were poor, illiterate, and did not know they had syphilis. The Tuskegee experiment did not result in any new knowledge or new treatment for syphilis, although the study continued for 40 years. The unethical, poorly designed project, with no clear scientific purpose, was made public and halted in 1972. (Scott-Jones, 1994, p. 98)
The devastation of the Tuskegee experiment led the U.S. Senate to hold hearings on research ethics in 1973. As a result, Public Law 93-348, the National Research Act, was passed in 1974 (Bowman, 1991). This act requires establishment of institutional review boards (IRBs) at all major research institutions. The National Research Act also calls for creation of a national commission on the protection of human participants (Scott-Jones, 1994). In light of the current, widely accepted ethical standards, obviously no project resembling the Tuskegee experiment today would be funded by any governmental agency or supported by any IRB (Scott-Jones, 1994). Failure to report may result from a researcher’s desire to examine a problem as it exists and progresses without intervention (Scott-Jones, 1994). Although this would no longer be approved in an extreme situation such as the Tuskegee experiment, it is fostered on one level by the no-treatment control groups in intervention research. Many low-income minority children participate in this standard research paradigm, which requires that a randomly selected group of children receive a presumed beneficial treatment and another randomly selected, and therefore equally needy group, be assessed without benefit of treatment (Scott-Jones, 1994). The ethical dilemma in the treatment-control model pits “good science” against “participant welfare” (Koocher & Keith-Spiegel, 1990). One view holds that research not directly benefiting its child participants is a violation of respect for humans, making a study with low-income children in no-treatment control groups unethical. The other view asserts that research should be allowed if it involves risks no greater than those children already encounter in everyday life; from this perspective, observing and assessing low-income children in control groups without intervention is ethical because it benefits children in general (Scott-Jones, 1994). This situation “allows for the interpretation that greater risk is acceptable in research with children exposed to danger in their everyday lives than in research with children who live in relatively safe environments” (Scott-Jones, 1994, p. 99). Failure to report to control group participants in the treatment-control model appears to support the prevention of harm while ignoring the provision of benefits.
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From the perspective of research implications for diverse groups, a strong argument can be made that, given the overwhelming sociopsychological problems that plague minority communities, this practice should no longer be considered ethical (Casas & Thompson, 1991). There are several ways in which the treatment-control dilemma can be altered so that it addresses intervention concerns in a manner that is beneficial to all participants. One suggestion is for the control group to receive the treatment after the treatment-control comparison is made; however, this is problematic where longitudinal designs are concerned (Scott-Jones, 1994). It is possible in longitudinal research with a control group to do a midexperiment check, where if the treatment group is showing significant improvement over the control group, then the latter can begin receiving the treatment as well (Fisher & Rosendahl, 1990). Other scientific and ethical alternatives include comparing possible beneficial treatments to each other without a notreatment control, intraindividual treatment, or comparing results of treatment groups to a carefully chosen established standard (Scott-Jones, 1994). The goal is to move away from a research design that excludes a group in need of services from experiencing the benefits of treatment.
Lack of Diversity Among Researchers In conducting research, it is advantageous for members of the groups being studied to have a central role in the research process. It is equally important for research to incorporate the perspective of the study population (Bowman, 1991). Given the lack of racial-ethnic minority faculty and staff on most campuses and research settings, however, it is difficult for these needs to be met. Recent statistics show that, in the 1995– 1996 academic year, 4% of faculty in U.S. graduate departments in psychology were African American, and 2% were Hispanic. Furthermore, these percentages reflect only a minimal increase over the past 15 years (American Psychological Association and Council of Graduate Departments of Psychology, 1997). The study of racial and ethnic issues in the social sciences has remained deeply grounded in societal folk beliefs about racial and ethnic differences (Scott-Jones, 1994). This may result in research that does not target the real needs of the minority community being studied. Presence of minorities as researchers increases the likelihood that reporting and referring, as well as other ethical issues, will be managed appropriately (Scott-Jones, 1994). Additionally, researchers should be actively involved in the recruitment and retention of racial-ethnic minority undergraduate and graduate students whom they can use as co-researchers and research assistants (Casas & Thompson, 1991). Minority student involvement can result in the development of better insights about the research process as well as increased motivation for involvement in other projects that may benefit minority communities. This suggestion is not meant to imply that White researchers should not study diverse groups. What is being suggested, however, is the view that racial-ethnic bias is inherently present. For example, Abramowitz and Murray (1983) concluded that ethnic minority and White researchers who examine the same data usually come up with completely opposite conclusions that are basically drawn along ethnic lines. Furthermore, “we each have our own way of interpreting data based on the cultural lenses through which we view the world, and we must guard against this bias when we as researchers, regardless of our ethnicity, study cross-cultural issues” (Atkinson, 1993, p. 220).
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Again, guarding against this bias does not mean that only ethnic minority researchers should conduct studies with ethnic minority groups. Each researcher, regardless of his or her background, has an important contribution to make. What is necessary, however, is to minimize the effects of researcher bias; one way in which this can be done is through the development of ethnically diverse research teams, with at least one member of each ethnic group sampled also represented on the research team (Atkinson, 1993). Additionally, IRBs, research funding agencies, and journal editorial boards need to be ethnically diverse so that proposals and manuscripts can be reviewed by panels that also reflect the diversity of the research population (Atkinson, 1993). By including at least one researcher on the investigatory team from the minority group targeted for study, the possibility of stereotyped views or distorted perception of ethical issues decreases. Given the growing ethnic diversity in this country and the disproportionate problems affecting ethnic minority communities, a lack of diversity among researchers may be perceived by some as an unethical practice.
Ethnic Minority Populations Are Inappropriately Studied and Understudied Negative stereotypes and lack of perspective on the real needs of minority communities may often lead to problem-focused research on ethnic minority populations. In addition, greater involvement of public agencies in offering services to ethnic-racial minorities results in these populations being more accessible to researchers studying psychological and social problems (Scott-Jones, 1994). For example, recruitment of African American children in intervention studies of children in poverty is not scientifically sound given the diversity of children and families living in poverty. Research on low-income African American children will not necessarily be generalizable to all children living in poverty (Scott-Jones, 1994). Ethnic minorities are constantly represented in studies focusing on psychological and social problems. Although it is true that there are excessive social and psychological problems existing in minority communities, minority and low-income populations are not likely to be recruited for research on normal developmental processes (ScottJones, 1994). This only exacerbates existing negative stereotypes, creating distance between the perspectives of researchers on issues impacting minorities and actual problems based on the reality and needs of the minority communities. Strategies for preventing inadequate study of ethnic-racial minority groups include involvement of ethnic minority investigators on the research team. Miranda (1996) emphasized the necessity for collaboration between ethnic minority and ethnic majority researchers in order to learn truly for whom and under what circumstances treatments work. Another strategy, suggested by Casas and Thompson (1991), is to meet with the targeted minority community to identify and prioritize research projects that the community members feel are noteworthy. They also suggested that researchers consider forming community-based advisory committees that continue to monitor the research and its success in meeting the real needs of the community. Inclusion of ethnic minorities in research, both as concerned citizens and as investigators, will ensure greater relevance in problems addressed with minority communities via research.
Culturally Insensitive Assessment Instruments Typically, assessment instruments have been designed by Europeans or North Americans and embody a Eurocentric world view and derivative psychometric technology
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(Dana, 1996). The term emic describes categories that are culture specific or totally isolated from other cultures. In contrast, etic refers to culture-general, or universal, categories (Pedersen, 1991). Many tests are emic measures designed for European Americans but have been assumed to be etic measures or pseudoetics because the equivalence of measures for use with different cultural groups has not been demonstrated (Dana, 1996). This problem often results in research processes that force minority groups to fit their experiences to rigid instruments developed with White male populations (Hall, 1993). Utilizing pseudoetic structures with multicultural populations feeds a process that results in many negative consequences for these communities. Initial use of these instruments already places minority groups in a position of being judged psychosocially in comparison to European American normative standards. This comparison falsely minimizes group differences, often culminating in stereotypes based on inappropriate interpretations from a European American perspective. These new “findings” in the form of stereotypes may inspire new research, and a new cycle begins. This assessment dilemma has continuous negative mental health consequences for visible racial and ethnic groups in the United States (Dana, 1996). A culture-specific or emic perspective requires assessors to become culturally competent. Cultural sensitivity, in this context, refers to the: ability to balance a consideration of universal norms, specific group norms, and individual norms in (a) differentiating between normal and abnormal behavior, (b) considering etiological factors, and (c) implementing appropriate interventions. . . . it is critical that clinicians vigorously assess what the client’s view is in regard to the supposed culturally normative behavior. . . . Cultural sensitivity then involves balancing different norms and constantly testing alternative hypotheses. (Lopez et al., 1989, p. 370)
The Guidelines for Providers makes the following, more specific suggestion as to how to conduct culturally appropriate research and assessment: Psychologists consider the validity of a given instrument or procedure and interpret resulting data, keeping in mind the cultural and linguistic characteristics of the person being assessed. Psychologists are aware of the test’s reference population and possible limitations of such instruments with other populations. (American Psychological Association’s Board of Ethnic Minority Affairs Task Force on the Delivery of Services to Ethnic Minority Populations, 1990, p. 2, 2d)
The first step in working toward culturally competent research and assessment is to increase awareness. Such awareness may result in researchers and clinicians seeking alternatives to the use of culturally inappropriate assessment tools. One solution is assessment of the single case using multiple methods which merges the approaches of the scientist and the practioner. Single-case procedures are part of a more personalized approach, serving as an antidote to an increasing technologization and depersonalization of the assessment process (Dana, 1996). In this approach, the assessor and client collaborate to develop an individualized assessment process or use methods that establish meaning by restoring a life context to assessment (Dana, 1996). In this approach, the data not only increase one’s understanding of the problem but also allow the client to receive and benefit from treatment. The effectiveness of this methodology provides a foundation for the true science of human behavior, with a focus on the paramount importance of the individual (Barlow & Hersen, 1984). Howard (1991) suggested that introspective narratives or storytelling can offer a credible de-
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piction of an individual’s subjective culture. The life story constitutes personal identity, with class, ethnicity, culture, and race providing the relevant roles in the story. Brislin (1993) also proposed that culturally competent assessment requires translations to be checked for equivalency in meaning and measurement. Cross-cultural validity requires that the existence of a metric measure of test constructs is verified. Furthermore, even when constructs do exist in other cultures, it is necessary to determine whether or not the meaning and subjective experience of these constructs are equivalent cross-culturally (Dana, 1996). Culturally sensitive research should include selection of tests on the basis of cultural orientation information. Gathering information on cultural orientation status should occur prior to the assessment process in order to determine both service delivery style and test content. Selection of tests with minority populations should account for uneven and individualized incorporation of behaviors and values from two cultures (Dana, 1996). Assessment tools should acknowledge participants as cultural beings; doing so will provide results that are more relevant to the needs of the populations being studied. This section has discussed only some of the many research concerns impacting ethnic minority groups: failure to report, lack of diversity among researchers, inappropriate study of ethnic minorities, and culturally insensitive assessment instruments. These concerns are a fair representation of the larger problem regarding research with ethnic minority populations: failure to acknowledge people as cultural beings and therefore not recognizing the implications this approach carries for ethnic-racial minority populations. Table 1 provides a summary of recommended responsibilities and criteria for cultural competence in research.
TABLE 1. Examples of Recommended Responsibilities and Criteria for Cultural Competence in Research Area of Concern Failure to report or inform
Diversity among researchers
Appropriate study of ethnic minority populations
Assessment
Criteria for Competence 1. Compare possible beneficial treatments to each other without a control group (Scott-Jones, 1994). 2. Give the potentially beneficial treatment to the control group if the treatment appears to be effective (Scott-Jones, 1994). 1. Recruitment and retention of racial minority graduate students to increase their involvement as co-researchers (Casas & Thompson, 1991). 2. Development of ethnically diverse research teams, with members of each ethnic group sampled represented on the team (Atkinson, 1993). 1. Meet with the targeted minority community to identify and prioritize research projects the community finds significant (Casas & Thompson, 1991). 2. Develop community-based advisory committees to monitor the research and its relevance to the needs of the community (Casas & Thompson, 1991). 1. Translations should be checked for equivalency in meaning and measurement (Brislin, 1993). 2. Select tests based on cultural orientation information (Dana, 1996).
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HOW DO THE APA DOCUMENTS IMPACT RESEARCH CONCERNS WITH MINORITY GROUPS? Cultural competence is a major ingredient in responsible mental health services, including research, for multicultural populations. It is evident by examining the Ethical Principles and Guidelines for Providers that APA is responding to the growing need for appropriate services that address the diverse and changing culture of this country. However, the question posed about APA’s acknowledgment of cross-cultural issues did not focus on whether or not these concerns were addressed but rather on the underlying philosophical premises and approach to these concerns. One concern raised over the Ethical Principles is the focus on the prevention of harm while ignoring the provision of benefits as this applies to minority communities (Casas & Thompson, 1991). Given the major sociopsychological problems plaguing minority communities, there should be a greater or at least equal emphasis on the benefits that can be provided to these groups. Earlier in this review, Payton’s (1994) view was expressed about APA’s movement away from the profession ideal for respect of the worth of the individual and protection of fundamental human rights. A different view for APA’s approach to cross-cultural concerns implies that the Ethical Principles fail to address minority groups explicitly but do so implicitly via a universal humanistic perspective that emphasizes the worth of all individuals (Casas & Thompson, 1991). This argument seems sound, especially in light of Ethical Principle 1.10 (Nondiscrimination), stated as follows: “In their work-related activities, psychologists do not engage in unfair discrimination based on age, gender, race, ethnicity, national origin, religion, sexual orientation, disability, socioeconomic status, or any basis proscribed by law” (Canter et al., 1994, p. 40). However, in spite of this seemingly universal concern for all people in Principle 1.10, one might come away with the sense that: care was taken to ensure that no one could complain about having been excluded. . . . The 1992 revision appears to be concerned with offering protection to psychologists first and foremost. . . . Removal of the many instances of exceptions to the rule would make the code more enforceable and more reflective of our discipline, which at one time was dedicated to the promotion of human welfare. (Payton, 1994, p. 320)
From either perspective, however, the rights of minority populations seem to be underemphasized. If the Ethical Principles are focusing on the rights of all individuals, there are two concerns. The first is that, given the context of discrimination that exists in our society, there may need to be more emphasis on this issue. Second, terminology such as “in their work-related activities” implies that it is permissible to not care about the fundamental rights of all outside of one’s role as a psychologist. From Payton’s (1994) perspective, lumping all groups together to avoid excluding any one community easily moves away from respecting the worth of the individual, especially the individual with special needs. This discussion is not meant to detract from APA’s efforts to address the special concerns of diverse groups. In fact, the Guidelines for Providers offers an impressive set of suggestions for culturally appropriate service delivery. However, although very valuable, these Guidelines may be underemphasized in the context of their aspirational (as opposed to enforceable) nature and their role of providing suggestions to service providers. Combined with the perspective that the Ethical Principles have glossed over the needs of minority populations, APA may be criticized despite obvious efforts
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to address the many ethical concerns impacting minority populations in a variety of psychological service contexts.
SUMMARY There has long been a need for culturally sensitive services, including those related to research endeavors. The APA has responded to this demand by addressing research concerns in both the Ethical Principles and the Guidelines for Providers. Although these steps are commendable and necessary, there may be additional ways in which to address these concerns. Apparently problematic are terms such as reasonable, feasible, and with due concern for, which may suggest rather than enforce cultural sensitivity. Such terminology may also de-emphasize the efforts that APA has put forth in this regard. In terms of conducting research ethically with minority populations, it requires a concern for the well-being of the individual participants. Without initial attempts to understand the special concerns related to ethnic minority participants, researchers cannot know what assessment and methodology is in the best interest for the group being studied. Services that are not in the best interest of the client or participant do not respect the worth and dignity of that person. This is questionable, and it is from an ethical perspective that problems related to cultural sensitivity should be initially addressed. Without the basic foundation of concern for the worth and dignity of others, culturally sensitive practices cannot bring about change in any realm of psychological services. Our article has explored some of the ethical considerations in conducting research with ethnic minority populations, specifically in relation to the following concerns: failure to report or inform research participants, lack of diversity among researchers, inappropriate study and understudy of minority populations, and culturally insensitive assessment instruments. Examination of these concerns has been useful in providing examples of recommended responsibilities and criteria for culturally competent research. These responsibilities address the importance of involving minorities in research projects, both as investigators and as concerned citizens. Other responsibilities include selection of test instruments based on cultural orientation information and comparison of possible beneficial treatments without a no-treatment control group. The overall theme for all of the recommended criteria is related to the broader problem regarding research with ethnic minority populations: failure to acknowledge people as cultural beings and therefore not recognizing the implications this approach carries for ethnic-racial minority populations. Continued exploration of ethical considerations relevant to the needs of ethnic minority populations can increase awareness and competence among researchers as well as psychologists working in other areas of service. REFERENCES Abramowitz, S. I., & Murray, J. (1983). Race effects in psychotherapy. In J. Murray & P. R. Abramson (Eds.), Bias in psychotherapy (pp. 215–255). New York: Praeger. American Psychological Association. (1953). Ethical standards of psychologists: A summary of ethical principles. Washington, DC: Author. American Psychological Association. (1992). Ethical principles of psychologists and code of conduct. American Psychologist, 47, 1597–1611. American Psychological Association and Council of Graduate Departments of Psychology. (1997, December
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11). Surveys of Graduate Departments of Psychology, 1981–82 through 1995–96. (Available from the APA Research Office, 750 First St., NE, Washington, DC, 20002-4242) American Psychological Association’s Board of Ethnic Minority Affairs Task Force on the Delivery of Services to Ethnic Minority Populations. (1990). Guidelines for providers of psychological services to ethnic, linguistic, and culturally diverse populations. Washington, DC: American Psychological Association. Atkinson, D. R. (1993). Who speaks for cross-cultural counseling research? The Counseling Psychologist, 21(2), 218–224. Barlow, D. H., & Hersen, M. (1984). Single-case experimental designs: Strategies for studying behavior change (2nd ed.). Needham Heights, MA: Allyn & Bacon. Bersoff, D. N. (1994). Explicit ambiguity: The 1992 ethics code as an oxymoron. Professional Psychology: Research and Practice, 25(4), 382–387. Bowman, P. J. (1991). Race, class, and ethics in research: Belmont principles to functional relevance. In R. L. Jones (Ed.), Black psychology (3rd ed., pp. 747–766). Berkeley, CA: Cobb & Henry. Brislin, R. W. (1993). Understanding culture’s influence on behavior. New York:Harcourt Brace Jovanovich. Canter, M. B., Bennett, B. E., Jones, S. E., & Nagy, T. F. (1994). Ethics for psychologists: A commentary on the APA ethics code. Washington, DC: American Psychological Association. Casas, J. M., & Thompson, C. E. (1991). Ethical principles and standards: A racial-ethnic minority research perspective. Counseling and Values, 35, 186–195. Dana, R. H. (1996). Culturally competent assessment practice in the United States. Journal of Personality Assessment, 66(3), 472–487. Deaner, S. L. (1997). The next step: Psychology graduate students and ethics. The Behavior Therapist, 20(8), 143–145. Fisher, C. B., & Rosendahl, S. A. (1990). Psychological risks and remedies of research participation. In C. B. Fisher & W. W. Tryon (Eds.), Ethics in applied developmental psychology: Emerging issues in an emerging field (pp. 43–59). Norwood, NJ: Ablex. Hall, J. M. (1993). What really works? A case analysis and discussion of confrontational intervention for substance abuse in marginalized women. Archives of Psychiatric Nursing, 7(6), 322–327. Howard, G. S. (1991). Culture tales: A narrative approach to thinking, cross-cultural psychology, and psychotherapy. American Psychologist, 46, 187–197. Koocher, G. P., & Keith-Spiegel, P. C. (1990). Children, ethics, and the law. Lincoln: University of Nebraska Press. Lopez, S. R., Grover, K. P., Holland, D., Johnson, M. J., Kain, C. D., Kanel, K., Mellins, S. A., & Rhyne, M. C. (1989). Development of culturally sensitive psychotherapists. Professional Psychology: Research and Practice, 20, 369–376. Miranda, J. (1996). Introduction to the special section on recruiting and retaining minorities in psychotherapy research. Journal of Consulting and Clinical Psychology, 64(5), 848–850. Payton, C. R. (1994). Implications of the 1992 ethics code for diverse groups. Professional Psychology: Research and Practice, 25(4), 317–320. Pedersen, P. B. (1991). Multiculturalism as a generic approach to counseling. Journal of Counseling and Development, 70, 6–12. Scott-Jones, D. (1994). Ethical issues in reporting and referring in research with low-income minority children. Ethics and Behavior, 4(2), 97–108. Sieber, J. E. (1994). Will the new code help researchers to be more ethical? Professional Psychology: Research and Practice, 25(4), 369–375. Sonne, J. L. (1994). Multiple relationships: Does the new ethics code answer the right questions? Professional Psychology: Research and Practice, 25, 336–343. Sue, D. W. (1990). Counseling the culturally different: Theory and practice. New York: Wiley. Vasquez, M. J. T. (1994). Implications of the 1992 ethics code for the practice of individual psychotherapy. Professional Psychology: Research and Practice, 25(4), 321–328.