Extending the Context-Responsive Psychotherapy Integration Framework to Cultural Processes in Psychotherapy

Psychotherapist competence in attending to cultural processes has long been considered an ingredient of successful treatment. Although some research findings support a positive association between clinician multicultural competence (MCC) and client improvement, others suggest that MCC may not be a skill that therapists uniformly acquire and then stably maintain. Rather, MCC is likely more fluid and contextualized, potentially rendering within-therapist variability across their patients and within-dyad variability across different moments in a given case. With such variability in perceptions and actual behavioral manifestations of therapist MCC, it may be important for clinicians to heed contextual markers that call for flexibility and evidence-informed responsivity. To this end, we extend Constantino, Boswell, Bernecker, and Castonguay's (2013) context-responsive psychotherapy integration framework, a pantheoretical, if-then approach to responding to common clinical process markers with modular, evidence-based therapeutic strategies. Specifically, we present a therapy case supporting that clients' social and cultural identities can serve as both specific-client contexts in themselves and unique factors that may influence other important therapeutic contexts (e.g., lowered client outcome expectation and alliance ruptures, client change ambivalence/resistance to treatment) that require context-relevant therapist responsivity. With this case, we provide examples both of successful responsivity and missed opportunities.