Colorado State University.
She returned to the University
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This document is copyrighted by the American Psychological Association or one of its allied publishers.
Melba J. T. Vasquez
Award for Distinguished Professional Contributions to
Independent or Institutional Practice in the Private
Sector
Citation
For outstanding devotion to the advancement of the ethi-
cal practice of psychology, with particular focus on treat-
ment for clients from diverse backgrounds. A full-time
clinician and a widely published scholar, Melba J. T.
Vasquez has provided significant leadership service, includ-
ing as a member-at-large of the APA Board of Directors,
as past president of the Texas Psychological Association
and of APA Divisions 17 and 35, and as a cofounder of
the National Multicultural Conference and Summit. She
applies approaches that are inclusive, collaborative, and
forward thinking, especially when bringing together diverse
groups to tackle complex problems in an atmosphere of
respect, mutual understanding, and a shared commitment to
the highest ideals of our profession.
Biography
Melba J. T. Vasquez received her doctoral degree in coun-
seling psychology from the University of Texas at Austin
and is a psychologist in full-time independent practice in
Austin, Texas. She practices with her life partner, Jim H.
Miller, a former educator and school principal. Her step-
daughter, Cecilia Miller, is a high school teacher.
From 1978 to 1982, Vasquez served as a university
counseling center psychologist and assistant professor at
November 2007 American Psychologist
Copyright 2007 by the American Psychological Association 0003-066X/07/$12.00
Vol. 62, No. 8, 875 885 DOI: 10.1037/0003-066X.62.8.875
of Texas at Austins Counseling & Mental Health Center
in 1992 as senior psychologist and taught courses in the
counseling psychology doctoral program. She served as
internship training director at both Colorado State Univer-
sity and the University of Texas at Austin. She has been in
full-time independent practice since 1991.
Vasquez grew up in a small, socially segregated central
Texas town, where she was very influenced by the involve-
ment of the grassroots civil rights activities engaged in by
her parents, her extended family, and her community. She
was fortunate to be among the first to benefit from the op-
portunities created in her community to attend college and
to be encouraged to seek higher education. She is the old-
est of seven children and is a first-generation college stu-
dent. Her father, the late Joe Vasquez Jr., was a tenant
farmer and also worked as a machine operator in a hanger
factory. Her mother, Ofelia Vasquez Philo, worked as a
housekeeper and a factory worker, then obtained her gen-
eral equivalency diploma and a bachelors degree, and was
employed as the executive director of a Community Action
Program, where she administered a multimillion-dollar
budget and supervised numerous social service programs in
central Texas. Vasquezs mother has always been a power-
ful role model for her; she was the first Latina to be
elected to the school board in the San Marcos Independent
School District. She is happy that she and all of her sib-
lings obtained at least an associates or bachelors degree.
Vasquezs first career was as a middle school teacher. Dur-
ing her work on a masters degree in school counseling,
she learned of and was encouraged to obtain the doctoral
degree in counseling psychology. Her motivation to learn
more about discrimination, oppression, resilience, and hu-
man behavior led to her interest in psychology.
Vasquezs parents activism and organizational and po-
litical leadership activities influenced her interest in profes-
sional political activities. Her initial involvement in leader-
ship activities included serving as an American
Psychological Association (APA) accreditation site visitor
(1980 1994) and in public-interest-oriented boards and
committees of the APA, including the Board of Social and
Ethical Responsibility in Psychology (19811984); the
APA Ethics Committee (1986 1989) and the APA Ethics
Committee Task Forces for Revisions of the Ethical Princi-
ples of Psychologists and Code of Conduct (for both the
1992 and 2002 versions); the Committee on Women in
Psychology (1990 1992); and the Board for the Advance-
ment of Psychology in the Public Interest (19911993), for
which she served as the first chair. She became involved in
professional practice policy development and advocacy in
serving as chair of the Board of Professional Affairs
(1994 1997) and as a member of the Committee for the
Advancement of Professional Practice (20012004). She
undertook broader policy development activities as a
875
 member of the Policy and Planning Board (1998 2000).
Vasquez is a past president of APA Divisions 35 (Soci-
ety for the Psychology of Women, 1998 1999) and 17
(Society of Counseling Psychology, 20012002) and of
the Texas Psychological Association (2006), for which
she often provided testimony to the Legislative Sunset
Review Commission and before the Texas State Board
of Examiners of Psychologists.
She has been involved in the planning and implementa-
tion of several key conferences, including the 1997 Supply
and Demand Conference and the 2002 Competencies Con-
ference. She is a cofounder, with Rosie Bingham, Lisa
Porche-Burke, and Derald Wing Sue, of the National Mul-
ticultural Conference and Summit (1999 and 2001), which
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
is now an ongoing biannual conference. She helped to es-
This document is copyrighted by the American Psychological Association or one of its allied publishers.
tablish Division 45, the Society for the Psychological
Study of Ethnic Minority Affairs, and served as the divi-
sions first Council of Representatives member. She was
also the Council of Representative member for Division
42, Psychologists in Independent Practice (2004 2006),
and for Division 17, the Society of Counseling Psychology
(1994 1997). She served as the first chair of the Ethnic
Minority Caucus and has been chair of the Womens Cau-
cus of the Council of Representatives. She is the first
Latina in the 117-year history of the APA to be elected to
serve on the APA Board of Directors (20072009).
Vasquez has been described as a tireless worker on be-
half of the psychology profession and brings to this work a
perspective and approach that is inclusive, collaborative,
and forward thinking. She regularly brings together diverse
groups of individuals to tackle complex and seemingly in-
surmountable challenges. Through her leadership, Vasquez
is able to bring these individuals together in an atmosphere
of respect, mutual understanding, and a shared commitment
to the highest ideals of the psychology profession. Because
of these strengths, she is often called upon to help address
unique problems in the association and has been asked to
serve on the following special task forces: APA Task Force
on the Revision of the Model Licensing Act (2006 2007,
chair); APA Council of Representatives Task Force on the
Report of the World Conference Against Racism (2004
2005); APA President Ron Levants Task Force on En-
hancing Diversity (2005); APA President Diane F. Halp-
erns Task Force on Public Policy, Work, and Families
(2004); APA Board of Educational Affairs Advisory Coun-
cil on the Committee on Accreditation (20032004); Ad
Hoc Council Committee on the Revision of Standards for
Educational and Psychological Testing (1994 1998, chair);
Ad Hoc Committee on Legal and Ethical Issues in the
Treatment of Interpersonal Violence (19951996, chair);
Task Force on Sexual Impropriety in Psychology (1990
1992); and Task Force on Communication with Minority
Constituents, Board of Ethnic Minority Affairs (1984
1986, chair).
876
She has published over 60 journal articles and book
chapters in the areas of ethics, ethnic minority psychology,
psychology of women, supervision and training, and coun-
seling and psychotherapy. Her interests in diverse groups,
including women and people of color, have been particular
foci of her writings. She has taught graduate courses and
has provided workshops and keynote presentations in those
areas as well. Along with Ken Pope, she is the author of
How to Survive and Thrive as a Therapist: Information,
Ideas, and Resources for Psychologists in Practice (Pope
& Vasquez, 2005) and Ethics in Psychotherapy and Coun-
seling: A Practical Guide (Pope & Vasquez, 2007). She
has served on numerous editorial boards and is interested
in the integration of science and practice and in the promo-
tion of psychological knowledge that contributes to human
welfare and the public interest.
Vasquez is an APA fellow of Divisions 1, 17, 35, 42,
45, 49, and 56 and is a member of Divisions 9, 31, and 44.
She is a diplomate of the American Board of Professional
Psychology. She is listed with the National Register of
Health Service Providers in Psychology and has received
numerous awards, including the following:
Woman of the Year, American Psychological Associ-
ations Division 17, Society of Counseling Psychology,
Section for the Advancement of Women, August 2006
Honorary doctoral degree, Phillips Graduate Institute,
May 2005
James M. Jones Lifetime Achievement Award, Ameri-
can Psychological Association, 2004
Psychologist of the Year, Texas Psychological Associ-
ation, November 2003
Foremother Award in Appreciation for Contributions
to the Section for the Advancement of Women, and Coun-
seling Psychology of Women, Society of Counseling Psy-
chology, Division 17, American Psychological Association,
2003
Eminent Women: 25th Annual Symposium on Histori-
cal and Personal Perspectives, American Psychological As-
sociation, 2003
Senior Career Award for Distinguished Contributions
to Psychology in the Public Interest, American Psychologi-
cal Association, 2002
Janet E. Helms Award for Mentoring and Scholarship,
Winter Roundtable on Cross-Cultural Psychology and Edu-
cation, Columbia University, 2002
Vision to Action Award, Austin Womens Psycho-
therapy Project, Kaleidoscope of Womens Lives Confer-
ence, 2002
John Black Award for Outstanding Achievement in
the Practice of Counseling Psychology, Division 17, Soci-
ety of Counseling Psychology, American Psychological
Association, 2000
The Distinguished Leader for Women in Psychology
November 2007 American Psychologist
 Award, Committee on Women in Psychology, American
Psychological Association, 2000
Award for Extraordinary Contributions in the Profes-
sional Practice of Counseling Psychology, Academy of
Counseling Psychology of the American Board of Profes-
sional Psychology, 2000
Outstanding Contribution to Public Service Award,
Texas Psychological Association, 1999
Distinguished Career Contributions to Service Award,
Division 45 of the American Psychological Association,
Society for the Psychological Study of Ethnic Minority
Issues, 1999
Selected Bibliography
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
This document is copyrighted by the American Psychological Association or one of its allied publishers.
Ginorio, A., Lapayase, Y. V., & Vasquez, M. J. T. (2007).
Gender equity for Latina/os. In S. S. Klein et al. (Eds.),
Handbook for achieving gender equity through education
(2nd ed., pp. 485500). Mahwah, NJ: Erlbaum.
Pope, K., & Vasquez, M. J. T. (2005). How to survive and
thrive as a therapist: Information, ideas, and resources for
psychologists in practice. Washington, DC: American Psy-
chological Association.
Pope, K., & Vasquez, M. J. T. (2007). Ethics in psycho-
therapy and counseling: A practical guide (3rd ed.). San
Francisco: Jossey-Bass.
Sue, D. W., Bingham, R. P., Porche-Burke, L., & Vasquez,
M. J. T. (1999). The diversification of psychology: A mul-
ticultural revolution. American Psychologist, 54, 1061
1069.
Vasquez, M. J. T. (2001a). Leveling the playing field: To-
ward the emancipation of women. Psychology of Women
Quarterly, 25, 89 97.
Vasquez, M. J. T. (2001b). Reflections on unearned advan-
tages, unearned disadvantages, and empowering experi-
ences. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, &
C. M. Alexander (Eds.), Handbook of multicultural coun-
seling (2nd ed., pp. 64 77). Thousand Oaks, CA: Sage.
Vasquez, M. J. T. (2002). Complexities of the Latina expe-
rience: A tribute to Martha Bernal. American Psychologist,
57, 878 888.
Vasquez, M. J. T. (2003a). 2002 Presidential Address: Ex-
tending the ladder of opportunityBreaking through the
colored glass ceiling. The Counseling Psychologist, 31,
115128.
November 2007 American Psychologist
Vasquez, M. J. T. (2003b). Ethical responsibilities in ther-
apy: A feminist perspective. In M. Kopala & M. A. Keitel
(Eds.), Handbook on counseling women (pp. 575580).
Thousand Oaks, CA: Sage.
Vasquez, M. J. T. (2003c). What to expect from ethical
psychotherapy. In L. Slater, J. H. Daniel, & A. E. Banks
(Eds.), The complete guide to mental health for women
(pp. 344 354). Boston: Beacon Press.
Vasquez, M. J. T. (2005). Independent practice settings and
the multicultural guidelines. In M. G. Constantine & D. W.
Sue (Eds.), Strategies for building multicultural compe-
tence in mental health and educational settings (pp. 91
108). Washington, DC: American Psychological Associa-
tion.
Vasquez, M. J. T. (2006a). Counseling men: Perspectives
and experiences of a woman of color. In M. Englar-Carl-
son & M. Stevens (Eds.), In the room with men: A case-
book of therapeutic change (pp. 241256). Washington,
DC: American Psychological Association.
Vasquez, M. J. T. (2006b). The varied, diverse and highly
interesting career opportunities of a counseling psycholo-
gist. In R. J. Sternberg (Ed.), Career paths in psychology:
Where your degree can take you (2nd ed., pp. 135160).
Washington, DC: American Psychological Association.
Vasquez, M. J. T. (2007a). Ethics for a diverse world. In J.
Frew & M. D. Spiegler (Eds.), Contemporary psychothera-
pies for a diverse world (pp. 20 40). New York: Hough-
ton Mifflin/Lahaska Press.
Vasquez, M. J. T. (2007b). Lillian Evelyn Moller Gilbreth:
The woman who had it all (1878 1972). In E. Gavin
(Ed.), Notable women psychologists (pp. 45 60). New
York: Springer.
Vasquez, M. J. T., Baker, N. L., & Shullman, S. L. (2002).
Assessing employment discrimination and harassment. In
I. B. Weiner (Series Ed.) & A. M. Goldstein (Vol. Ed.),
Comprehensive handbook of psychology (Vol. 11, pp. 259
278). New York: Wiley.
Vasquez, M. J. T., & Comas-Daz, L. (2007). Feminist
leadership among Latinas. In J. L. Chin, B. Lott, J. K.
Rice, & J. Sanchez-Hucles (Eds.), Women and leadership:
Transforming visions and diverse voices (pp. 264 280).
Washington, DC: American Psychological Association.
Vasquez, M. J. T., Han, A. L., & de las Fuentes, C. (2006).
Adaptation of immigrant girls and women. In J. Worell &
C. D. Goodheart (Eds.), Handbook of girls and womens psy-
877
 chological health: Gender and well-being across the lifespan
(pp. 439446). New York: Oxford University Press.
Vasquez, M. J. T., & Jones, J. M. (2006). Increasing the
number of psychologists of color: Public policy issues for
affirmative diversity. American Psychologist, 61, 132143.
Vasquez, M. J. T., Lott, B., Garcia-Vazquez, E., Grant,
S. K., Iwamasa, G. Y., Molina, L. E., et al. (2006). Per-
sonal reflections: Barriers and strategies in increasing di-
versity in psychology. American Psychologist, 61, 157
172.
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This document is copyrighted by the American Psychological Association or one of its allied publishers.
Cultural Difference and the Therapeutic
Alliance: An Evidence-Based Analysis
Melba J. T. Vasquez
Austin, Texas
The research on positive psychotherapy outcome
consistently indicates that the quality of the alliance is
important across different models of psychotherapy
(D. E. Orlinsky, M. H. Ronnestad, & U. Willutzki, 2004;
B. E. Wampold, 2000). Social psychological research has
documented how unintentional bias can produce
barriers to university admissions, employment, and
advancement of well-qualified members of ethnic minority
groups (J. F. Dovidio, S. L. Gaertner, K. Kawakami, & G.
Hodson, 2002). Neuroscience is further confirming social
psychological responses associated with race (J. L. Eberhard,
2005). Unintentional bias identified in social psychological
research may be part of the psychotherapist/client interaction,
interfere with the therapeutic alliance, and partly account
for the high dropout rates and underutilization of
psychotherapeutic services by people of color. The purpose
of this article is to provide an evidence-based analysis of how
Editors Note
Melba J. T. Vasquez received the Award for Distinguished
Professional Contributions to Independent or Institutional
Practice in the Private Sector. Award winners are invited
to deliver an award address at the APAs annual conven-
tion. A version of this award address was delivered at the
115th annual meeting, held August 1720, 2007, in San
Francisco, California. Articles based on award addresses
are reviewed, but they differ from unsolicited articles in
that they are expressions of the winners reflections on
their work and their views of the field.
878
psychologists in practice may unintentionally interfere with
development of quality alliances with culturally different
clients or patients and thus contribute to the barriers to
effective multicultural counseling and psychotherapy.
Principles from the American Psychological Associations
(2003) multicultural guidelines and a review of relevant
research are applied in suggesting strategies to reduce bias
and to develop culturally appropriate skills in psychological
practices.
Keywords: multicultural counseling, therapeutic alliance, ev-
idence-based analysis, multicultural guidelines, uninten-
tional bias
Psychotherapy is a change process designed to provide
symptom relief, personality change, and prevention of fu-
ture symptomatic episodes and to increase the quality of
life, including the promotion of adaptive functioning in
work and relationships, the ability to make healthy and
satisfying life choices, and other goals arrived at in the
collaboration between client/patient and psychotherapist
(APA Presidential Task Force on Evidence-Based Practice,
2006). Unfortunately, ethnic minority populations underuti-
lize psychotherapy services and have high rates of drop-
ping out of treatment (Casas, Vasquez, & Ruiz de Esparza,
2002; Center for Mental Health Services, 1998; U.S. De-
partment of Health and Human Services, 2001). One of the
purposes of this article is to identify variables that could
potentially interfere with as well as enhance the outcome
of psychotherapy with ethnic minority populations. The
working alliance is a particular focus, and this evidence-
based information is applied to psychotherapy with ethnic
minority populations.
The Effectiveness of Psychotherapy
The APA Presidential Task Force on Evidence-Based Prac-
tice (2006) provided a definition of evidence-based practice
in psychology as the integration of the best available re-
search with clinical expertise in the context of patient char-
acteristics, culture, and preferences (p. 273). The task
force also concluded that psychologists must attend to a
range of outcomes that may sometimes suggest one strat-
egy and sometimes another, and they must also attend to
the strengths and limitations of available research regarding
these different ways of measuring success.
The empirical evidence on the outcomes of counseling
and psychotherapy informs psychotherapists that, generally,
treatment is effective for a broad range of problems, diffi-
culties, and psychopathology, regardless of the therapeutic
approach of the clinician (Lambert & Archer, 2006; Wam-
pold, 2000). That is, in most control group studies in coun-
seling and psychotherapy, treated persons are found to be
more functional and less distressed than are untreated per-
sons as a result of treatment (Wampold, 2000). In a review
of hundreds of studies, both qualitative and quantitative,
November 2007 American Psychologist
 Lambert and Ogles (2004) found that about 75% of clients
who enter treatment show some benefit. Only with those
diagnosed with severe biological-based disturbances, such
as bipolar disorder and the schizophrenias, were psycholog-
ical treatments secondary to psychoactive medications
(Lambert & Archer, 2006). Overall, however, psychologi-
cal interventions have been found to be equal to or to sur-
pass the effects of medication for psychological disorders.
Psychological interventions are less dangerous and less
intrusive, and when psychotherapy and medication are of-
fered together, psychotherapy reduces the likelihood of re-
lapse once medications are withdrawn.
In a review of studies examining outcomes of individual
counseling and psychotherapy, Lambert and Archer (2006)
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and Wampold (2000) concluded that various psychotherapy
This document is copyrighted by the American Psychological Association or one of its allied publishers.
treatments intended to be therapeutic are beneficial, regard-
less of approach; when all available meta-analytic reviews
comparing different psychotherapies were collected, these
studies usually indicated little difference between treat-
ments (Lambert & Ogles, 2004). However, some analyses
found that some disorders (e.g., phobias, panic disorder)
respond to treatment more easily than others (e.g., obses-
sive-compulsive disorder), and some require longer and
more intense interventions (Lambert & Archer, 2006). Un-
der some limited circumstances, certain methods (such as
applying behavior techniques that rely on systematic expo-
sure to fear-provoking situations with anxiety disorders) are
superior in outcome. Even then, surprisingly small differ-
ences between the outcomes were found (Lambert & Ar-
cher, 2006).
Wampold (2000) further suggested that evidence sup-
ports the common factor model as opposed to the specific
ingredient model. That is, specific ingredients in treatments
do not produce superior outcomes to others; rather, the
ritual, with a set of procedures and common factors,
seems necessary and sufficient for therapeutic change.
Those specific ingredients are indeed necessary, Wampold
suggested, to develop a coherent treatment that provides a
convincing rationale to clients and in which therapists have
faith. Carter (2006) also identified common factors and
components of all forms of psychotherapy. Both Carter
(2006) and Wampold (2000) cited Frank and Franks
(1991) position to further articulate the common factors.
Frank and Frank believed that the success of all techniques
depends on the patients sense of alliance with the healer.
They suggested that therapists should learn as many ap-
proaches as they find congenial and convincing and then
select for each patient the therapy that accords, or can be
brought to accord, with the patients personal characteris-
tics and view of the problem. Frank and Frank further
stated that creating a good therapeutic match may involve
both educating the patient about the therapists conceptual
scheme and, if necessary, modifying the scheme to take
November 2007 American Psychologist
into account the concepts the patient brings to therapy
(p. xv).
Wampold (2000) agreed. He suggested that
the evidence strongly favors letting clients select a psycholog-
ical treatment that makes sense to them and permitting thera-
pists to adapt treatments to be consonant with the attitudes,
values, and culture of the client, rather than having third-party
payers or health maintenance organizations mandate a particu-
lar treatment. (pp. 735736)
Wampold (2000) and Frank and Frank (1991) proposed
that therapists must select among models and interventions
and apply them as appropriate to each client. Marcia Hill
(2004), author of Diary of a Country Therapist, stated,
One really has to be a chameleon, oneself always, but
changing with the emotional tone, needs, and personal style
of the other individual. Thirty clients, thirty different thera-
pies, thirty different therapists (p. 45). Martha Stark
(1999) described how the
optimal therapeutic stance is one that is continuously chang-
ing. . . . Moment by moment, the therapists position shifts.
How the therapist decides to intervene depends on both what
she has come to understand about the patient by virtue of the
listening position she has assumed and what she believes the
patient most needswhether enhancement of knowledge, a
corrective experience, or interactive engagement in relation-
ship. (p. 5)
The Therapeutic Alliance
The therapeutic alliance has been identified as one of the
most important of the common factors in therapeutic effec-
tiveness (Warwar & Greenberg, 2000). Ahn and Wampold
(2001), for example, concluded that training models should
focus on the common factors as the bedrock of skills nec-
essary to become an effective practitioner, including the
importance of interviewing skills, establishment of a thera-
peutic relationship, and the core facilitative conditions such
as those that have historically interested humanistic, dy-
namic, and relational researchers and clinicians.
The therapeutic alliance may be defined as the quality
of involvement between therapist and client or patient, as
reflected in their task teamwork and personal rapport, and
the therapists contribution to the alliance is an important
element of that involvement (Orlinsky, Ronnestad, & Wil-
lutzki, 2004). Carter (2006) suggested that both clinicians
and researchers should attend to the therapeutic relation-
ship and the working alliance (often referred to synony-
mously). The role and impact of the alliance, as well as the
ways in which the alliance as a relationship can be en-
hanced, should be the foci of attention. Given that the ther-
apeutic relationship has strong evidentiary support as an
essential factor in successful outcomes, clinicians should
devote considerable attention to building and maintaining a
strong therapeutic relationship in the implementation of
879
 evidence-based practice. The relationship rests on agree-
ment of goals, tasks, and processes and is positively related
to outcomes.
Huppert, Fabbro, and Barlow (2006) provided a chal-
lenge to the interpretation of the outcome research; they
suggested that although the therapeutic relationship is nec-
essary, it may not be a sufficient factor in producing posi-
tive therapeutic outcomes. Given the difficulty in identify-
ing specific mechanisms that produce a good alliance,
Huppert et al. suggested that the outcomes of psychological
treatments are also determined by the manner in which
therapists execute specific techniques. They proposed that
because some studies suggest that a positive alliance leads
to better treatment compliance, the more powerful the
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
treatment strategies, the greater the benefit from a strong
This document is copyrighted by the American Psychological Association or one of its allied publishers.
alliance. Thus, the reverse is also possible: The more effec-
tive the strategy, the better developed the alliance may be-
come. There are indications that with some types of prob-
lems (e.g., cocaine abuse), the alliance is not correlated
with outcome within structured treatments, although it was
strongly related to outcome in supportive psychotherapy
(Carroll, Nich, & Rounsaville, 1997). Indeed, the quality of
the alliance may be a phenomenon, or result, of positive
treatment change. However, many studies do show evi-
dence for the therapeutic alliance as a mediator of change;
evidence has been collected showing that outcomes can be
predicted from early alliance ratings (Salvio, Beutler,
Wood, & Engle, 1992). Continued research will provide
more clarity about these complex variables. Regardless of
cause and effect, it is important to identify issues related to
the therapeutic alliance with ethnic minority clients.
Threats to the Alliance for Ethnic Minority
Clients/Patients
Attention to the therapeutic relationship and the working
alliance with clients/patients of color may require special
considerations. What are the unique issues that may inter-
fere with the therapeutic alliance of clients different from
psychotherapists? Ethnic minority populations underutilize
psychotherapy services and have high rates of dropping out
of treatment (Casas et al., 2002; Center for Mental Health
Services, 1998; U.S. Department of Health and Human
Services, 2001). Multiple reasons most likely account for
these unfortunate findings, but one possibility may be that
many ethnic minority clients do not experience the alliance
as described by Carter (2006), Frank and Frank (1991), M.
Hill (2004), Lambert and Archer (2006), Stark (1999), and
Wampold (2000). Related causes include cultural misun-
derstandings and miscommunications between psychothera-
pists and clients (American Psychological Association
[APA], 2003).
Psychologists who provide psychotherapy services have
a responsibility to work only with those who are within the
boundaries of their competence (APA, 2002). Standard 2 of
880
the APA Ethics Code focuses on competence, and the im-
plication is that psychologists refer clients with whom they
do not think they can provide effective services. One issue
is that psychologists may not always be aware of when the
potential for developing an effective therapeutic alliance
may be compromised.
C. E. Hill, Thompson, Cogar, and Denman (1993) and
others have suggested that psychotherapists need to be sen-
sitive to the tendency for clients to defer and conceal nega-
tive reactions by creating opportunities for clients to ex-
press their reactions. Clients may hide reactions out of fear
of rejection if they express negative feelings to the thera-
pist, as well as out of deference to the therapists authority.
Concealment of negative reactions is a normal human pro-
cess. However, if the therapeutic alliance is one of the
most important aspects in therapeutic effectiveness (C. E.
Hill & Nutt Williams, 2000), then it would be helpful to
be aware of potential negative reactions on the part of cli-
ents that interfere with the development of a positive alli-
ance or cause alliance ruptures. Psychologists would poten-
tially enhance effectiveness if they focused on the
development of skills and processes that promote a positive
therapeutic alliance. People of color experience slights and
offenses so regularly that there is a tendency for them to
edit their responses on a regular basis. That reality, com-
bined with cultural values, may further inhibit negative
reactions.
Although there is mixed evidence, most clients of color
are more comfortably matched with therapists similar to
them (Casas et al., 2002). More specifically, clients work-
ing with clinicians of similar ethnic backgrounds and lan-
guages tend to remain in treatment longer than do clients
whose therapists are not ethnically or linguistically
matched (S. Sue, 1998). However, such matches are not
always possible. In addition, matches do not guarantee a
healthy therapeutic alliance.
Social psychological research that sheds light on racial
and ethnic minority relationships with White members of
society may help psychologists understand more about the
risks in interactions between groups, such as biases in gen-
eral, and in the psychotherapy process in particular.
Social Psychological Research: Implications for
Psychotherapy
One assumption of this article is that the same interper-
sonal dynamics that occur in everyday life may also occur
in the psychotherapeutic office. Indeed, psychotherapy is
often a microcosm of interactions out in the world except
insofar as the psychotherapist is providing helpful interven-
tions and working to ensure that destructive interactions do
not occur in the process. Microaggressions is a term
coined to convey power dynamics in interactions in cross-
cultural encounters that convey attitudes of dominance,
superiority, and denigration: that a person with privilege is
November 2007 American Psychologist
 better than the person of color, who is less intelligent, ca-
pable, worthy, and so forth (Fouad & Arrendondo, 2007;
D. W. Sue, 2003). Microaggressions are often perpetrated
by well-meaning people who hold egalitarian beliefs but
who have not become aware of their negative attitudes and
stereotypes about people of color and/or who have not had
sufficient contact with people different from themselves
(Fouad & Arrendondo, 2007). To what degree do these
microaggressions occur in psychotherapy between White
clinicians and clients of color? To what degree do they
occur for any psychotherapist with those clients different
from him or her by virtue of differences based on any fac-
tor that is negatively socially constructed without privilege
in society? In addition to race and ethnicity, differences
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
may include gender; age; gay, lesbian, bisexual, or trans-
This document is copyrighted by the American Psychological Association or one of its allied publishers.
gender identity; socioeconomic status; religious affiliation;
and disability status.
The nature of the role of psychotherapist confers power
that can be beneficial in facilitating constructive change
(D. W. Sue & Sue, 2003). Practitioners must be careful to
understand and remember this power and take care to not
abuse it. The privilege that is conferred upon practitioners
by virtue of possessing a doctorate is often unspoken but is
a central dynamic in the psychotherapeutic relationship.
Historically, power has also been a factor in cross-cultural
encounters (Fouad & Arredondo, 2007; D. W. Sue & Sue,
2003).
Steeles (1997) stereotyped threat research indicates shape who they are themselves in ways never before
that when ethnic minorities are asked to perform a task in
which ethnic minorities stereotypically underperform, they
end up underperforming, due to the threat, fear, and anxi-
ety of underperforming. Ethnic minority clients may be
particularly sensitive to the experiences of negative judg-
ment, rejection, and criticalness on the part of White thera-
pists, without the White therapist being aware of this sensi-
tivity. Because of a history of oppressive and rejecting
experiences, many if not most ethnic minorities are easily
shamed. Therapists may not always know when they con-
vey negative judgments in body language, including facial
expressions, voice tone, and eye contact.
Greenwald and Banaji (1995) suggested that social
structure influences cognitive judgment and leads to im-
plicit attitudes and unconscious effects. Human social
structures have compounding effects on peoples cognitive
structures and ultimately on their social attitudes and be-
liefs about others. The way society constructs societal rep-
resentations of groups affects the social order and has a
tremendous impact on the identities of individuals in vari-
ous groups, both ethnic minority and White majority.
Social psychological research (Dovidio et al., 2002) has
continued to document how unintentional bias can produce
barriers to university admissions, employment, and ad-
vancement of well-qualified members of ethnic minority
groups. As much as people perceive themselves to be egal-
November 2007 American Psychologist
itarian, they are not subconsciously so as individuals in this
society. Dovidio et al. (2002) demonstrated in a series of
studies that contemporary racism among Whites is subtle,
often unintentional, and unconscious. Many Whites often
give off negative body language (less eye contact, voice
tone not as warm or natural) in response to those different
from themselves. Whites who demonstrate these behaviors
report not being aware of this negativity. Members of eth-
nic minority groups were aware of negative attitudes to-
ward them in those studies that examined these interac-
tions.
Neuroscience is further confirming social psychological
responses associated with race. The use of functional mag-
netic resonance imaging is a noninvasive means of examin-
ing the functioning of healthy brains. Eberhardt (2005)
demonstrated the process by which ideas about racial
groups produce physical changes in the brains of individu-
als; these come to shape who those individuals are. Social
variables can influence biological brain development (Sie-
gel, 1999). Essentially, studies reviewed by Eberhardt indi-
cated that Whites exhibit more positive evaluation bias
(greater amygdala response habituation) to in-group White
faces than to out-group Black faces. Blacks exhibit a more
positive evaluation bias to Blacks than do Whites. Eber-
hardt reported optimism in believing that seeing pictures of
the brain may lead people to understand that their own
race-based perceptions have the capacity to change and
thought possible.
The implication of these studies is that even psychother-
apists may exhibit unintentional bias in their work with
clients or patients who are culturally different from them.
Overcoming Psychotherapist Bias
Some, if not most, ethnic minority clients have experiences
of discrimination to address in psychotherapy, usually in
addition to other issues. What happens in psychotherapy
when an ethnic minority conveys the perception of an un-
fair evaluation or that a lack of promotion has to do with
prejudice and discrimination? What if the facial expression
of the therapist reflects disbelief? What if the client may be
struggling with a failure experience/event, without perceiv-
ing the possibility of discrimination, when discrimination is
in fact a part of the process? What happens for that indi-
vidual client when the therapist fails to suggest bias/dis-
crimination as a possible factor?
The White therapist who has negative stereotypes about
the competency of marginalized group members may have a
difficult time staying present and empathic with the person of
color who is struggling with a painful discriminatory event or
a cultural experience foreign to the psychotherapist. One study
(Nelson & Baumgarte, 2004) demonstrated that individuals
experience less emotional and cognitive empathy for a tar-
get experiencing distress stemming from an incident re-
881
 flecting unfamiliar cultural norms and that this reduction of
empathy is mediated by a lack of perspective taking on the
part of the observer. These findings suggest that representa-
tions of prior experience as well as lack of similarity be-
tween self and other can have a negative impact on the
ability to mediate perspective taking or empathy on the
part of the observer.
Comas-Daz (2006) discussed how cross-cultural en-
counters are frequently rife with missed empathetic oppor-
tunities. They include those moments when a client re-
ports emotional issues and the clinician changes the topic
without addressing or reflecting the clients feelings. Co-
mas-Daz contended that these missed empathetic opportu-
nities are subtle but more frequent when clinicians work
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
with those different from them on the basis of racial, eth-
This document is copyrighted by the American Psychological Association or one of its allied publishers.
nic, gender, sexual orientation, socioeconomic, ideological,
and political differences.
The reality is that, given the sociopolitical context in
which people exist, they are all influenced by racism, eth-
nocentrism, sexism, heterosexism, and other -isms whether
they are conscious of those or not. The APA (2003) Guide-
lines on Multicultural Education, Training, Research,
Practice and Organizational Change for Psychologists
(hereafter referred to as multicultural guidelines) include
various assumptions and guidelines that address this reality.
The first multicultural guideline exhorts psychologists to
recognize that, as cultural beings, they may hold attitudes
and beliefs that can detrimentally influence their percep-
tions of and interactions with individuals who are ethni-
cally and racially different from themselves (p. 382).
Thus, psychologists are encouraged to continually engage
in activities that promote self-awareness and self-explora-
tion in becoming aware of unconscious beliefs and bias
and to reduce stereotypic attitudes.
Developing the Therapeutic Alliance With Ethnic
Minority Clients/Patients
Ackerman and Hilsenroth (2003) identified therapists per-
sonal attributes and in-session activities that positively in-
fluenced the therapeutic alliance from a broad range of
psychotherapy orientations. Personal attributes found to
contribute positively to the alliance included being flexible,
honest, respectful, trustworthy, confident, warm, interested,
and open. Techniques such as exploration, reflection, noting
past therapy success, accurate interpretation, facilitating the
expression of affect, and attending to the patients experience
were also found to contribute positively to the alliance.
Although these attributes and techniques may very well
work with clients of color, Comas-Daz (2006) suggested
the careful application of any evidence-based findings,
given the dearth of research with populations of color. In-
dividuals of one cultural group may require a form of psy-
chotherapy and a stance by the therapist different from oth-
ers. For example, cognitive behavior therapists may need to
882
assess the role of racism and oppression in their clients abil-
ity to achieve mastery and agency. Racial stress management
may be an additional empowering technique for clients who
have experienced oppression systemically. The therapeutic
relationship may be even more important with immigrants
who feel distrustful of authority figures in this country. Some
culturally diverse clients may be unsettled with the egalitarian
and nondirective interaction styles of some therapists. Others
may be put off by an authoritarian stance. These are fac-
tors and issues that must be continuously assessed, as cul-
tural groups vary and as individuals within those groups
are heterogeneous, based on acculturation, language, gener-
ational status, and other related factors (APA, 2003).
APAs second multicultural guideline encourages psy-
chologists to recognize the importance of multicultural
sensitivity/responsiveness to, knowledge of, and under-
standing about ethnically and racially different individuals
(APA, 2003, p. 385). The more psychologists understand
about those with whom they work, including understanding
their worldview and perspective, the more likely they are
to promote a therapeutic alliance. This implies learning as
much as possible about the various values, norms, and ex-
pectations of various ethnic and racial group members with
whom one works. The challenge in learning about cultural
groups is to avoid stereotyping; rather, the knowledge is to
be used to assess the degree of application of various cul-
tural values, behaviors, and expectations. Comas-Daz
(2006) suggested that although the therapeutic relationship
requires special attention in multicultural dyads, clinicians
need to tailor the relationship to the clients interpersonal
and developmental needs, a suggestion in keeping with that
of Frank and Frank (1991), M. Hill (2004), Stark (1999),
and Wampold (2000). A very good suggestion is to learn
the clients uses of words to facilitate and guide learning of
a new common language, as well as to teach the client
concepts in the therapeutic dialogue.
Comas-Daz (2006) explored the role of culture within
the therapeutic relationship and provided recommendations
for addressing the cultural components of the client/thera-
pist relationship to increase psychotherapy effectiveness.
She especially suggested modification of the therapeutic
relationship to the clients culture, special attention to un-
derstanding the clients voice, development of trust and
credibility, and the promotion of cultural empathy.
In addition, a culturally sensitive psychotherapist would
use a variety of interventions that take into account the
needs of clients. This assessment process is complex and is
informed by self-awareness, cultural knowledge, and famil-
iarity with the evidence base of treatments, preferably
those that include ethnic minority populations in the re-
search samples. Not only must psychotherapists possess
sophisticated and ongoing self-awareness, but they must
continuously evaluate their theories, assumptions, practices,
and clinical skills to correctly apply culturally resonant
November 2007 American Psychologist
 interventions to accommodate the needs of the wide variety
of clients with whom they work. The abilities required to
engage in integration of this evidence-based knowledge and
processes are often what distinguishes a doctoral-level cli-
nician from others.
Ponterotto, Fuertes, and Chen (2000) summarized sev-
eral models of multicultural counseling. All are helpful in
potentially providing knowledge, skills, and awareness in
improving effectiveness in counseling and psychotherapy
with ethnic minority populations. In the multicultural
guidelines, the APA (2003) also promotes valuable guide-
lines with which to promote effective treatment, and others
(Constantine, 2007; Constantine & Sue, 2005; de las Fu-
entes, 2007; Fouad & Arrendondo 2007; D. W. Sue, 2003;
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Vasquez, 2005) have applied the multicultural guidelines to
This document is copyrighted by the American Psychological Association or one of its allied publishers.
psychotherapy in particular.
Other suggestions include D. W. Sues (2003) conten-
tion that one develops a nonracist White identity by first
acknowledging that ones racism exists. As long as one
denies racism, the greater the difficulty in developing an
authentic and positive White identity. In addition, D. W.
Sue (2003) suggested that every individual is responsible
to combat racism, not only in themselves but in society at
large. He encouraged people of color to also continue to
fight for dignity and humanity, regardless of how tired,
impatient, or angry they feel. D. W. Sue (2003) also sug-
gested that hope is an important antidote to surrender bit-
terness and blind hatred.
De las Fuentes (2007) and Hardy and Laszloffy (1995)
suggested the use of a cultural genogram as a didactic/
experiential training tool to promote awareness of how the
family is the principal mode by which people learn and
develop an understanding about their cultures and ethnici-
ties. Clinicians can learn about their own unique values,
transmitted through their families and experiences, as well
as learn better how to assess those for their clients, espe-
cially those different from them.
A hopeful note is that the psychotherapeutic process
generally provides the opportunity, if the psychotherapist is
open to it, to become intimately acquainted with the
strengths and resilience of ones clients. Feminist and mul-
ticultural approaches in particular, but also others, empha-
size the empowerment of individuals and work toward the
increased quality of life for all people. Cultural mutuality,
as defined by the Guidelines for Providers of Psychological
Services to Ethnic, Linguistic, and Culturally Diverse Popula-
tions (APA, 1990), describes, in part, the importance of relat-
ing to clients of color, women, and other oppressed groups in
a respectful, connecting manner based on psychotherapists
knowledge of clients culture and also tuning in to aspects of
the clients needs that their therapeutic processes may help.
This is an important value for psychotherapists who wish to
promote alliances with persons of color and others who have
been historically disenfranchised.
November 2007 American Psychologist
Conclusion
The social construction of race and ethnicity in this country
means that everyone suffers from unintentional biases, re-
sulting in discriminatory, oppressive behaviors that result
in microaggressions and other offenses. It is highly likely
that these attitudes and behaviors extend to the process of
psychotherapy. Change involves awareness of biases, and
the ability for psychotherapists to promote knowledge, atti-
tudes, and skills important to the cultures of those with
whom they work. The therapeutic alliance, of significant
importance in a positive therapeutic outcome, may be posi-
tively or negatively affected by the choices that psycho-
therapists make in overcoming those -isms. Various activi-
ties and experiences are suggested in the literature, and all
practitioners have a responsibility to engage in those en-
deavors. The APA (2003) and others (Constantine, 2007;
Constantine & Sue, 2005; de las Fuentes, 2007; Fouad &
Arrendondo 2007; D. W. Sue, 2003; Vasquez, 2005) have
suggested a variety of strategies to reduce bias and to pro-
mote a healthy and constructive therapeutic alliance. The
first and most critical is constant awareness of attitudes.
Other strategies involve effort and practice in changing the
automatic favorable perceptions of the White privileged
group and negative perceptions of those whose historical
roles in society have been left with negative perceptions
(Vasquez, 2005). According to Dan Siegel (1999), psycho-
therapists can rewire their circuitry through explicit pro-
cessing of their biases, immersion with different groups
and individuals, readings, training, and practice in behaving
in ways to change their subconscious perceptions in the
psychotherapeutic process (staying attuned to clients, dem-
onstrating cultural empathy, being respectful and open to
worldviews). They can change their neural pathways devel-
oped through negative biases and stereotypes in society
(Eberhardt, 2005; Siegel, 1999).
More research is recommended to assess the quality of
the therapeutic alliance and how that affects outcome for
clients of color. This would be a complicated endeavor, as
results of studies investigating the therapeutic alliance of-
ten consider different treatment modalities, with mostly
heterogeneous groups of patients with various disorders.
However, it is an important goal, both to determine the
degree to which it is a problem in the psychotherapeutic
underutilization of services for clients of color, as well as
to identify unique factors related to the promotion of the
therapeutic alliance in cross-cultural dyads.
Authors Note
Correspondence concerning this article should be ad-
dressed to Melba J. T. Vasquez, Anderson House at Heri-
tage Square, 2901 Bee Cave Road, Box N, Austin, TX
78746. E-mail: melvasquez@aol.com
883

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