


































GSJP Volume 16 final


Graduate Student Journal of  Psychology
2015, Vol. 16

Copyright 2015 by the Department of  Counseling and Clinical Psychology
Teachers College, Columbia University

71

Ethical Research With People Of  Color:
Implications For Clinical And Community Applications

Alicia San Miguel, B.S.
Jennifer Moniz, M.S.

Washington State University 
Department of  Educational Leadership and Counseling Psychology

Mental health counseling and research with ethnic minorities and indigenous communities within the United States 
has evolved; yet cultural consideration should be evaluated in evidence-based research. Some of  the common errors 
in research include generalizing cultural groups and using White norms for comparison. The outcome of  marginal-
ization of  these communities has developed mistrust with healthcare providers. This conceptual paper establishes 
WKH�UHOHYDQFH�RI �FXOWXUDO�GLIIHUHQFHV�DFURVV�PDQ\�GRPDLQV�DQG�LGHQWLÀHV�D�FRPPRQ�FRUROODU\�LQ�RUGHU�WR�KHOS�DOOH-
viate past injustices of  the ethnic minority population and indigenous communities.      Given these past injustices, 
it is vital to discuss avenues that will minimize detrimental effects.  and examine possibilities for improving cultural 
and ethical standards in two regards: in client and therapist relationship and within social psychology research. 

 Developing a culturally sensitive environment 
in psychotherapy research is a growing need, eco-
nomically and empirically. The current number of  
ethnic minority individuals in the United States is 
rising quickly (Mindt, Byrd, Saez, & Manly, 2010). 
According to the U.S. Census Bureau (2014), it is es-
timated that ethnic minorities (all diverse populations 
other than non-Hispanic Whites) compromise 37% 
the general population and that number is projected 
to increase to 57% of  the population in 2060. Of  
those ethnic minorities, a percentage are of  indige-
nous origin (Cunningham & Stanley, 2003).  With this 
increasing diversity, we as social scientists and prac-
titioners are compelled to humbly adapt in therapeu-
tic application and in psychological research. 
 This paper will comprehensively examine cultur-
ally appropriate ways to collect data from ethnic mi-
nority and/or indigenous communities and culturally 
HIÀFLHQW� ZD\V� WR� DSSO\� HYLGHQFH�EDVHG� WUHDWPHQWV��
Perspectives on the issue will incorporate culturally 
competent care from multitudes of  frameworks in-
cluding those from biomedical research, sociopolit-
ical research, healthcare research, and psychological 
research. In order to reach the expectations of  valu-
ing clinical applications with ethnic minorities, we will 
examine the distinct characteristics that differentiate 
cultures (interdependence, spirituality, discrimination; 

Hall, 2001), critically assess the common errors found 
in research, and offer culturally sound practices for 
therapeutic application and/or research data collection 
in ethnic minority and/or indigenous communities.
 There are dissimilar characteristics among cul-
tural groups of  ethnic minorities and indigenous 
communities; these include a group’s sociopolitical 
context and the historical relationship to their par-
ticular geographical region. As authors we chose to 
VSHFLÀFDOO\�LGHQWLI\�WKHVH�WZR�PDMRU�FKDUDFWHULVWLFV�LQ�
evaluating cultural considerations. Although indige-
nous communities such as Aboriginals of  Australia, 
American Indians (First Nations), Native Hawaiians, 
and the Maori of  New Zealand fall under the um-
brella term indigenous owing to political coloniza-
tion, we will not discuss sociopolitical implications. 
Rather we favor using the term indigenous (specif-
ically in the United States) through “an attractive 
GHÀQLWLRQµ��6WDQOH\��������S��������,QGLJHQRXV�FRP-
PXQLWLHV�SODFH�VLJQLÀFDQW�HPSKDVLV�RQ�KRZ�WKH\�UH-
late to the natural world, which is strikingly different 
from other worldviews. Three main worldviews in-
clude (a) the Judeo-Christian (Western) view in which 
God is external and heaven is above, (2) the Eastern 
view in which concentration is inward (e.g., in med-
itation), and (3) the Indigenous view in which peo-
ple have essential relationships with nature including 
WKH� ODQGVFDSHV� RI � WKHLU� FRPPXQLW\³WKHLU� ULYHUV��
mountains, seas, and land (Royal, 2003). Respectful-
ly, we regard the label of  indigenous according to 
WKLV� GHÀQLWLRQ� UDWKHU� WKDQ� WKH� GHÀQLWLRQ� DVVRFLDWHG�

Keywords: Indigenous research, Indigenous, counseling diversity, 
Culturally diverse, counseling psychology, counseling research, 
diversity research, counseling competencies. 
Corresponding author: alicia.sanmiguel@wsu.edu  



72

SAN MIGUEL, MONIZ

with the  sociopolitical restraints of  people affect-
ed by colonization (Blaser, Harvey, & McRae, 2004).
 Although there are distinctions in experienc-
es among ethnic minorities (e.g., Asian Americans, 
Mexican Americans/Latinos(as), African Ameri-
cans) and those in indigenous communities, a com-
PRQDOLW\� RI � H[SHULHQFH� H[LVWV� LQ� LPSURSHU� LGHQWLÀ-
cation, compared with a White norm or standard, 
issues of  microaggression, and mistrust of  health-
care providers. We will discuss these themes as well 
as attempt to offer alternatives for alleviating these 
issues through culturally appropriate means of  col-
lecting research data in these communities and cultur-
ally sound ways of  applying therapeutic techniques. 

Common Errors Found in Research 
Grouping-Mislabeling
 Ethnicity and race are two of  the most distin-
guishable terms used in ethnic minority research, yet 
they have been used interchangeably. Ethnicity de-
notes shared values, culture, traditions, and sense of  
identity and group; it is a socially created construct 
WKDW� LV� XWLOL]HG� IRU� LGHQWLÀFDWLRQ� �%KRSDO� 	� 6HQLRU��
1994). Race is more biologically driven and sociopo-
litical in context.  In the realm of  research, the terms 
ethnicity and race are utilized interchangeably and 
further complicate the cultural divisions that exist in 
each origin of  race and/or ethnicity. For example, an 
individual is of  one race but can identify from various 
HWKQLF�DIÀOLDWLRQV��H�J��(WKQLF�LGHQWLÀFDWLRQ�DV�3ROLVK�
DQG�,ULVK�EXW�HVVHQWLDOO\�FODVVLÀHG�DV�RQH�UDFH��ZKLWH�������
� ,Q� JHQHUDO�� HWKQLFLW\� LV� GLIÀFXOW� WR� LGHQWLI\� LQ�
and out of  research. Grouping large cultures with-
RXW� GHÀQLQJ� WKH� GLVWLQFWLRQV� EHWZHHQ� WKHP� DQG�
then comparing them may create confounding fac-
tors and/or common errors.  For example, group-
ing commonly occurs through the collection of  
Federal data (e.g., U.S. Census; Miranda, Lawson, & 
(VFREDU�� ������� WHUPLQRORJ\� LQFOXGHV� WKH� FODVVLÀ-
cation of  four categories: Hispanic, non-Hispanic, 
Asian, and Caucasian. This terminology is ambigu-
RXV� DQG� ODFNV� DQ\� VSHFLÀF�PHDQLQJ� �%KRSDO�� �������
 Let us evaluate the term Hispanic for a moment. 
7KH�WHUP�+LVSDQLF�ZDV�ÀUVW�FRLQHG�RQ�WKH������8QLW-
HG�6WDWHV�&HQVXV�IRU�GHPRJUDSKLF�FODVVLÀFDWLRQ�SXU-
SRVHV��$OWKRXJK� WKLV� LQVWDQFH�ZDV� WKH�ÀUVW� WLPH� WKH�

8�6�� JRYHUQPHQW� RIÀFLDOO\� UHFRJQL]HG� WKLV� FXOWXUH��
use of  the term aggregated many cultures with Span-
LVK�RULJLQV�ZLWKLQ� WKLV� VLQJOH� FODVVLÀFDWLRQ� �5HLPHUV��
2005). Individuals of  Spanish origin but from differ-
ent regions including Mexico, Cuba, Puerto Rico, and 
Central and South America were all categorized into 
one label, one umbrella term, Hispanic. However, this 
term does not differentiate the many cultural differ-
ences among geographic regions. The Mexican-her-
itage population alone varies in legal status, time in 
the United States, race/phenotype, generation status, 
DQG� ODQJXDJH�ÁXHQF\� �*DUFtD�� ������/ySH]�	�6WDQ-
ton-Salazar, 2001). The use of  the one category of  
+LVSDQLF�ZLWKRXW�GHÀQLQJ�WKH�XQLTXH�FKDUDFWHULVWLFV�
of  any discrete cultures (e.g., Mexican American vs. 
Cuban) creates a misrepresentation, and simply speak-
ing, is too broad of  a label.  There is a very distinctive 
difference between a Mexican American (e.g., Chi-
cano(a), Latino(a)) who was born in the United States 
and a Puerto Rican, who was born and raised in Puer-
to Rico but recently immigrated to the United States. 
 In terms of  labeling with the term Hispan-
LF�� QRW� DOO� LQGLYLGXDOV� DJUHH� ZLWK� WKLV� LGHQWLÀFDWLRQ��
Some individuals in the Hispanic/Latino(a) com-
munity associate the term with the negative conno-
WDWLRQV� RI � JDQJ� DIÀOLDWLRQ�� XQHPSOR\PHQW�� DQG� ORZ�
degrees of  education (Austin & Johnson, 2012). In 
some areas of  the United States (e.g., Los Angeles), 
WKLV� VHOI�LGHQWLÀFDWLRQ� LQ� WKH� +LVSDQLF�/DWLQR�D��
community has been noted as a development of  an 
“emerging ethnic consciousness” (Reimers, 2005, p. 
32). So depending on the geographic region of  the 
United States and the relationship one has with his 
or her identity, an individual of  the Hispanic/Latino 
community may self-identify differently. Hispanic/
Latino(a) individuals may identify according to their 
geographic region (e.g., Cuban, Chicano(a), Lati-
QR�D���RU�HYHQ�0HVWL]R�� VHOI�LGHQWLÀFDWLRQ� LQ� UHVSHFW�
of  Spanish and Amerindian roots; Schaefer, 2000). 
 Similarly, this transition into more acknowledge-
DEOH�� UHVSHFWIXO�� DQG� HPSRZHULQJ� VHOI�LGHQWLÀFDWLRQ�
has occurred for African Americans, Asian Ameri-
cans, and American Indians. The standard terms have 
transitioned from “colored” to “Negro” to “Black” 
to “African American” and “oriental” to “Asian” 
(Dajani, 2001). The common goal in the evolutionary 



73

ETHICAL RESEARCH WITH PEOPLE OF COLOR

changes with labeling is an attempt to socially rede-
ÀQH�RQH·V�RZQ�JURXS��LQVWLOO�JURXS�SULGH��DQG�LPSDUW�
greater self-esteem (Smith & Tom, 1992). It is vital 
in discussion, research, or in the therapeutic realm 
WR� LQYHVWLJDWH� WKH� FXOWXUDO� YDOXHV� DQG� LGHQWLÀFDWLRQ�
of  the subgroups rather than focus on an umbrella 
term that aggregates cultural/ethnic populations into 
one massive assembly. This descriptive distinction is 
EHQHÀFLDO�RXW�RI � UHVSHFW� IRU� WKH�XQLTXH�GLIIHUHQFHV�
each ethnic community or indigenous communi-
ty has in conjunction with their experiential history.     

The White Standard
 The comparative approach of  using the White 
population as the norm or standard is concerning 
to say the least. With the growing interest in health 
disparities with ethnic minorities and indigenous 
communities, the normalizing population that was 
used for comparison shifted to the White (Cauca-
sian) population. Although this shift was necessary 
to understand some of  the variables that contributed 
to health disparities in that population, we as social 
researchers and mental health professionals are now 
ORRNLQJ�DW�YDULRXV�RWKHU�GLIIHUHQFHV��VXFK�DV�HIÀFDF\�
of  treatments (e.g., cognitive-behavioral therapy with 
American Indians). Researchers should evaluate the 
XQGHUO\LQJ� KLVWRULFDO� DQG� VRFLRSROLWLFDO� MXVWLÀFDWLRQ�
regarding how and why the White population should 
be appropriate as the standard control. In the same 
regards, the outcome of  evaluating such health dis-
parities has been translated in the media to be a nega-
tive perspective of  health in diverse communities. Al-
WKRXJK�LW�LV�GLIÀFXOW�WR�FRQWDLQ�WKH�SHUVSHFWLYH�RXWVLGH�
the construct of  research, it is pertinent that those 
conducting research with culturally rich communi-
ties be aware of  the high impact that may result from 
implications found in studies. Furthermore, another 
possible avenue of  alleviating this negative perception 
of  ethnic minority health disparities is through ana-
lytical discussion of  its social and cultural relevance 
in peer reviewed journal articles to clarify distinctions 
(Bhopal, 1997). For example, may of  the factors that 
contribute to health disparities (e.g. Hispanics and 
African-American’s are twice as likely as whites to 
have diabetes mellitus) are due to structural bases of  
racism such as lack of  access, stigma surrounding ill-

ness, and lower income rather than direct biological 
correlations (Neville, Spanierman & Lewis, 2012). 
Mistrust of  Healthcare Providers 
 Another barrier that prevents adequate repre-
sentation of  ethnic minorities and indigenous pop-
ulations includes a prominent mistrust of  healthcare 
providers (Miranda et al., 2002). According to the 
Commonwealth Fund Minority Health Survey, 43% 
of  African Americans, 28% of  Latinos, and 5% of  
Whites felt mistreated by healthcare providers be-
cause of  their cultural background (Boulware, Coo-
per, Ratner, Laveist, & Powe, 2003). This mistrust 
may originate from direct experience of  the indi-
vidual due to social cues (e.g., media) or from sec-
ondhand experiences (Boulware et al., 2003). This 
FRQFHUQ� OHDGV� WR� GLIÀFXOWLHV� LQ� FRQGXFWLQJ� VWXGLHV�
WKDW� DGHTXDWHO\� UHÁHFW� WRGD\·V� GLYHUVH� FRPPXQLWLHV��
If  there is fear, hesitation, and mistrust on behalf  
of  the participant with a healthcare profession-
DO��PRUH� VSHFLÀFDOO\� D� UHVHDUFKHU�� LW� ZRXOG� EH� GLIÀ-
cult to ascertain the validity of  the data collected. 
 Historically, mistrust has arisen due to the ill 
ZLOO� WKDW� KDV� EHHQ� LQÁLFWHG� XSRQ� HWKQLF� PLQRULW\�
and indigenous populations. One major instance 
of  major ethical racial bias is known as the Tuske-
gee Syphilis Study (Reverby, 2009). In 1932, United 
States public health doctors observed the course 
of  syphilis in hundreds of  African American men, 
offering little to no treatment even after the discov-
ery of  penicillin in a study called the United States 
Public Health Service Study of  Untreated Syphilis 
in the Male Negro at Tuskegee. This tainted study 
LV�LPSULQWHG�RQ�RXU�VRFLHW\�DQG�UHÁHFWV�XQHWKLFDO�DE-
errances in medical research. At a later date, it was 
discovered that the same doctor involved with the 
syphilis studies had also done a similar unethical 
study regarding syphilis being introduced into Gua-
temala prison populations with no consent (Reverby, 
2011). In response to an article published by Reverby 
(2011) on the occurrences of  this maltreatment on 
individuals in Guatemala without informed consent, 
Hillary Rodham Clinton, then Secretary of  State, 
and Kathleen Sebelius, then Secretary of  the De-
partment of  Health and Human Services (DHHS), 
offered a formal apology to the people of  Guatema-
la; President Barack Obama expressed his distress as 



74

well to the President of  Guatemala (Reverby, 2011).
 Another such misappropriate handling was the 
negative perception of  African Americans during 
certain political eras in the United States. In the 
1850s, psychiatrists labeled African American slaves 
who were compelled to run away from their White 
masters with a mental illness called drapetomania; lat-
er accounts were also noted in medical journals of  
a form of  madness called dysaesthesia aethiopis when 
African American slaves disrespected their master’s 
property (Metzl, 2010). Although we have progressed 
into a more culturally sensitive environment, some 
of  the most recent experiences of  this negative per-
ception of  African Americans is as recent as the 
civil rights movement. In the 1960s, as the political 
movement of  the civil rights uproared, the medical 
community translated their political reactions into 
a new diagnosis. In Bromberg and Simon’s (1968) 
article “The ‘Protest’ Psychosis: A Special Type of  
Reactive Psychosis,” they denote a form of  schizo-
phrenia that African American men develop with 
hostility, rage, and delusional anti-Whiteness after 
listening to Malcolm X or aligning with any politi-
cal militant resistance to the social order of  Whites. 
 The negative perception of  African American 
men and hostility due to the political resistance was 
DOVR�GHÁHFWHG�LQ�DQWLSV\FKRWLF�PHGLFDWLRQ�DGYHUWLVH-
ments such as those for Haldol (haloperidol). These 
advertisements in the 1970s depicted a photo of  an 
$IULFDQ� $PHULFDQ� PDQ� ZLWK� D� FOHQFKHG� ÀVW� �RIWHQ�
seen in militant groups during the civil rights era), 
XQGHU� D� FDSWLRQ� $́VVDXOWLYH� DQG� EHOOLJHUHQW"� &RRS-
eration often begins with Haldol or Haloperidol” 
(Metzl, 2012). Although it has been more than four 
decades since the publication of  these campaign 
DGV�DQG�EODWDQWO\� UHÁHFWHG� UDFLVW� VWHUHRW\SHV�RI �$I-
rican American men, this skewed perception is still 
an open wound and continues to lay a foundation of  
mistrust between patient and medical professional. 
 Although not discussed here, other indigenous 
communities have been subjected to ill care by the 
PHGLFDO� ÀHOG�� )RU� H[DPSOH��$PHULFDQ� ,QGLDQ�ZRP-
en underwent unethical sterilizations in the 1970s 
by the Indian Health Services without consent or 
just medical cause (Carpio, 2004). The indescribable 
shame and fear that arose out of  this experience 

has silenced an already oppressed culture. The ster-
ilization process was due to the belief  that Native 
American women were a substantial threat to the 
colonial structure since they could reproduce anoth-
er generation of  colonial resistance (Smith, 2003). 
 The cultivation of  many of  these negative ex-
periences from various ethnic/cultural backgrounds 
and indigenous communities still impact everyday in-
WHUDFWLRQV��VSHFLÀFDOO\�ZLWK�PHGLFDO�FRPPXQLWLHV��,Q�
order for the medical community to rebuild a foun-
dation with ethnic minority and indigenous commu-
nities, we must ethically approach individuals and be 
sensitive to cultural values in research data collection 
and in the clinical and therapeutic realm. Clinical 
interaction themes that are more relevant to ethnic 
minority and indigenous populations include interde-
pendence, spirituality, and discrimination (Hall, 2001). 

Implications for Therapeutic Environment

� ,W� LV� GLIÀFXOW� WR� XQGHUVWDQG� ZKLFK� WUHDWPHQWV�
work with which populations if  previous research 
has not carefully considered the cultural nuances 
among the various ethnic minority communities and/
or indigenous communities. The American Psycho-
logical Association (APA) has developed objectives 
to consider this sociocultural framework in psycho-
logical assessment, case formulation, therapeutic 
relationship, and intervention through an integrat-
ed approach called the Evidence-Based Practice in 
Psychology (EBPP; La Roche & Christopher, 2009). 
The EBPP denotes a more comprehensive approach 
to evidence-based practices that is more culturally 
sound and sets the tone for future evidence-based 
psychotherapy research (APA, 2006). However, al-
though APA has acknowledged the need to be cul-
turally sensitive to the needs of  our diverse patients, 
there still has not been adequate evidence that eth-
QLF� PLQRULW\� SRSXODWLRQV� DUH� SURSHUO\� UHÁHFWHG� LQ�
UHVHDUFK� �0LUDQGD� HW� DO��� ������� ,Q� RUGHU� WR� ÀOO� WKLV�
gap, we will discuss the common themes that are 
relevant across various ethnic, cultural and/or in-
digenous communities. These themes include issues 
of  interdependence, spirituality, and discrimination. 
Common Ground: Interdependence, Spirituali-
ty, and Microaggressions

SAN MIGUEL, MONIZ



75

� 9DULRXV� WUHDWPHQWV� KDYH� EHHQ� LGHQWLÀHG� DV� HYL-
dence-based treatments for certain groups but have 
QRW� EHHQ� DGHTXDWHO\�PRGLÀHG� IRU� FXOWXUDOO\� GLYHUVH�
populations. For example, one of  the most widely 
used manualized treatments is cognitive-behavior-
al therapy (Beck, Rush, Shaw, & Emery, 1979). One 
ZD\� WR� DGHTXDWHO\� UHÁHFW� D� FXOWXUDOO\� ULFK� SDWLHQW� LV�
to utilize culturally sensitive treatments, which mod-
ify clinical interventions to be unique to the indi-
YLGXDO� DQG� WKHLU� FRPPXQLW\�� 6RPH� PRGLÀFDWLRQV�
include incorporating cultural components into clin-
ical applications, for example, using racial identity 
development for African Americans (Carter, 1995), 
evaluating empowerment and indigenous problem 
solving for American Indians (LaFromboise, Trim-
ble & Mohatt, 1998), identifying healing and value 
systems with Asian Americans (Root, 1998), and 
discussing the family unit with Latino Americans 
(Szapocznik, Kurtines, Santisteban, & Pantin, 1997). 
 One such example of  a culturally sensitive mod-
LÀFDWLRQ�LQFOXGHV�&XHQWR�WKHUDS\�IRU�/DWLQR�D���+LV-
panic populations. Cuento therapy is based on Ban-
dura’s social learning theory; it utilizes cuentos (Spanish 
language folk stories) in a cognitive and emotional 
framework to improve outcomes related to role-play-
LQJ�� VRFLDO� LQWHUDFWLRQ�� UHÁHFWLRQ�� DQG� GLVFXVVLRQ�
(Ramirez, Jain, Flores-Torrez, Perez, Carlson, 2009). 
7KH�IRON�VWRULHV�DUH�LGHQWLÀHG�WR�EH�FXOWXUDOO\�UHVSRQ-
sive on the various differences between Latino(a)/ 
Hispanic cultures. However, this form of  culturally 
adapted therapy is limited such that not many stud-
ies have applied this approach across various Lati-
no(a)/Hispanic populations. Otherwise, these forms 
RI � PRGLÀHG� WKHUDSLHV� DUH� YDOXDEOH� LQ� WKH� HIIRUWV�
of  a culturally sound application in psychotherapy. 
 Apart from culturally sound treatments, we 
can evaluate common themes across various eth-
nic minority and/or indigenous communities. The 
themes that run through various multicultural ap-
plications include interdependence, spirituality, and 
discrimination as they relate to family and commu-
nity. These constructs vary across different ethnic 
minorities but remain focal points of  discussion. 
European Americans are less likely to value inter-
dependence and value internal attributes more than 
other groups such as Latino Americans and Afri-

can Americans (Suro & Wesman de Mamani, 2013). 
Furthermore, interdependence is emphasized more 
in collectivist cultures than in individualist cultures. 
 Interdependence. Although the individual-
ism-collectivism construct varies on a spectrum, 
VRPH�VWXGLHV�KDYH�LGHQWLÀHG�DWWULEXWHV�RI �LQGLYLGXDO-
ism as being higher in the United States, Britain, and 
Australia and collectivism attributes as being higher 
in samples from Africa, Asia, and Latin America (Tri-
andis, McCusker, & Hui, 1990).  Culturally sensitive 
therapy incorporates common values at the commu-
nity level (e.g. using family therapy for a culture that 
values the family unit) in order to approach cultur-
al groups with more interpersonal emphasis (Hall, 
2001). A common mistake in application of  family 
therapy is using the European American middle class 
model with an individual from a culturally rich fam-
ily with a dynamically different outlook, one parallel 
to collectivist values, such as those of  Asian Ameri-
cans, Latinos(as), and the like. Similarly, interdepen-
dence plays a large role in the matter of  intrapsychic 
forces in the human experience for ethnic minorities 
and indigenous cultures (Yeh, Hunter, Madan-Bahel, 
Chiang, & Arora, 2004). In other words, if  a men-
tal health professional personally views the distinc-
tion of  mind and body as separate, that lens of  bias 
will cause a disconnect between the client and mental 
health professional. According to Western psycholo-
gy, there is a line of  separation between spirituality, 
mental health, physical health, and overall well-being 
(Grills & Ajei, 2002; Sue & Sue, 1999).  To clinically 
treat patients in a culturally and ethically appropri-
ate manner, we should be attentive to such biases. 
 Spirituality. The view of  approaching spiritual 
values has evolved within the application of  diverse 
populations. The attention on this issue has grown 
GXH�WR�WKH�VLJQLÀFDQFH�RI �LWV�LQWHUZRYHQ�IHDWXUHV�ZLWK�
various multicultural dimensions including spiritu-
al traditions, values, and worldview practices (Pow-
er, 2005). In providing care for an ethnic minority 
or indigenous patient, spirituality may be an avenue 
for discussion. Such application that is pertinent to 
therapy through prayer or evaluating spiritual heal-
ing experiences may be applicable in some cases 
where spiritual support is warranted in their family 
and/or community. The European American per-

ETHICAL RESEARCH WITH PEOPLE OF COLOR



76

spective of  religiosity is different that other ethnic 
minority groups; in other various cultures spirituality 
LV� KLJKO\� LQÁXHQWLDO� RQ� WKH� VRFLDO� DQG� SROLWLFDO� FRQ-
struct of  the community (Hall, 2001). For example, 
spirituality for Chicano/Latino individuals shapes 
the way in which they raise their children in a social 
environment; the family is viewed as a “protective 
sanctuary” that honors their ancestors and engrains 
generational wisdom to the younger generations 
through prayers of  God, angels and saints (Koss-Chi-
onio & Vargas, 1999; Cervantes & Ramirez, 1992).  
 Microaggressions. A pertinent theme that 
should be acknowledged with a culturally diverse cli-
ent is the experience of  discrimination and/or racial 
microaggression. These issues could be perceived as 
a hypervigilant response to the environment; howev-
er, it is evident that ethnic minorities experience dis-
crimination much more than European Americans 
(Hall, 2001). Although discriminatory practices are 
less common currently than in the period before the 
Civil Rights movement and the Chicano Movement, 
discrimination still persists (Thomson & Neville, 
1999).  Discrimination has manifested into what is 
termed racial microaggression. Racial micro-aggres-
sions are “brief  and commonplace daily verbal, be-
havioral, and environmental indignities, whether in-
tentional or unintentional, that communicate hostile, 
derogatory, or negative, racial slights and insults to 
the target person or group (Sue et al., 2007, p. 273).” 
In order to competently address ethnic minorities 
and/or indigenous communities, mental health pro-
fessionals should develop cultural competency, via 
cultural humility, to alleviate bias or microaggressions. 
 This also contributes as noted earlier in the paper 
to issues of  mistrust between healthcare providers 
and ethnic minorities, which leads to discrepancies 
in care. For example, European Americans are more 
likely than ethnic minorities to obtain mental health 
care and are less likely to be misdiagnosed with psy-
chotic disorders or depression (Alvidrez & Areán, 
2002). In research alone, mistrust has evolved by ear-
O\�H[SORLWLYH�VRFLDO�MXVWLÀFDWLRQ�RI �HGXFDWLRQDO�VHJUH-
gation and slavery that is too vast a topic to discuss 
in this article (e.g., Drapetomania: irrational desire of  
slaves to run away; Bhopal, 1997). Attitudes and per-
spectives towards mental health are valid issues worth 

discussing with an ethnic minority client. This discus-
sion brings to light the generalizing of  ethnic minori-
ties through research errors and bias that emphasize 
health disparities rather than the underlying contri-
bution factors that cause these health disparities.
 How do we alleviate these errors in the ther-
DSHXWLF� HQYLURQPHQW"� +RZ� GR� ZH� DFNQRZOHGJH�
WKH� LQMXVWLFHV� RI � WKH� SDVW� DQG� UHEXLOG"� :H� FDQ�
begin to heal the open wounds that the medi-
cal community has indirectly caused through the 
application of  cultural competence, cultural hu-
PLOLW\�� DQG� IRFXVLQJ� RQ� FXOWXUH�VSHFLÀF� QHHGV�

Culturally Relevant Applications in  
Client-Therapist Interactions

Cultural Competence
 Multicultural Counseling Competency. One 
RI � WKH� SULPDU\� FRQFHSWXDO� IUDPHZRUNV� WKDW� ÀUVW�
made headway in the multicultural world of  coun-
VHOLQJ� SV\FKRORJ\� VSHFLÀFDOO\� ZDV� WKH�0XOWLFXOWXUDO�
Counseling Competencies (MCC) model by Sue et al. 
(1982). This framework had initiated a call to pro-
gram accreditation standards (American Counseling 
Association, 2005), licensing regulations (Council 
for Accreditation of  Counseling and Related Edu-
cational Programs, 2001), and mental health provid-
er standards (APA, 2003). The model can be widely 
adapted for many cultural, ethnic, and/or indigenous 
populations. It consists of  three areas of  emphasis: 
(a) attitudes and beliefs: being aware of  own attitudes, 
beliefs, biases, assumptions, and values of  another 
culture; (b) knowledge: learning and understanding 
the worldview of  other cultural backgrounds; and 
(c) skills: learning adequate intervention techniques 
DQG� VWUDWHJLHV� WR�ÀW� WKH�XQLTXH�QHHGV�RI � WKH� FOLHQW��
In order to have a high quality experience in train-
ing, students should seek cultural information and 
experiences (of  self  and other cultures), commu-
nicate and collaborate with other cultural groups, 
attend cultural events, and be open to learning 
about other cultural values/practices (Ridley, 2005). 
Cultural Humility
 Although cultural humility is minimally discussed 
within counseling psychology research, we should 
take into consideration that it is utilized across bio-

SAN MIGUEL, MONIZ



77

medical research and nursing research. Cultural hu-
mility differs from cultural competency; cultural 
KXPLOLW\�GRHV�QRW�IRFXV�RQ�D�ÀQLWH�HQGSRLQW�RI �VDW-
isfying cultural competencies but rather on openness 
to the other (Hook, Owen, Davis, Worthington, & 
Utsey, 2013, p. 354). In other words, whereas MCC 
is viewed as a way of  applying and doing, cultural 
humility is approaching openness and a way of  being 
with culturally diverse clients (Hook et al., 2013). Cul-
tural humility is an evolving and dynamic process that 
LQYROYHV�WKH�FOLHQW·V�FXOWXUDO�QHHGV�� WKH�UHÁHFWLRQ�RI �
the therapist’s worldview, and appreciates that there 
is no end goal, rather a pursuit for development.  
 Encompassing a much deeper process of  re-
ÁHFWLRQ��FXOWXUDO�KXPLOLW\�GRHV�QRW�IRFXV�RQ�FRPSH-
tence but rather on the recognition that daily expo-
sure to various cultures affects the therapist’s views 
and brings about the realization of  how much is not 
known about other cultural groups (Yeager & Bau-
er-Wu, 2013). In a meta-analysis, perceived cultural 
humility of  the therapist (from the client) over-
lapped with the client ratings of  the therapeutic al-
liance in positive outcomes (Owen, Imel, Adelson, 
& Rodolfa, 2012). So it is believed that with more 
salient cultural humility on behalf  of  the therapist, 
the client may experience positive outcomes through 
a sense of  self, increasing motivation and instilling 
hope (Wampold, 2007). On a smaller scale, counsel-
ing psychologists should cater to the unique needs 
RI �WKHLU�FOLHQWV��DQG�WKHVH�FXOWXUH�VSHFLÀF�QHHGV�FDQ�
EH� LGHQWLÀHG�ZLWKLQ�$3$·V�DSSURDFK�WKURXJK�(%33��
&XOWXUH�6SHFLÀF�1HHGV�7KURXJK�(%33� EBPP 
has demonstrated the suggestions needed to identify 
FXOWXUH��VSHFLÀF�QHHGV�LQ�WKH�WKHUDSHXWLF�HQYLURQ-
PHQW��$OWKRXJK�(%33�KDV�EHHQ�EULHÁ\�UHYLHZHG�LQ�
this paper, we should demonstrate the emphasis of  
this framework with culturally diverse populations. 
One of  the objectives clearly emphasized through-
out the EBPP guidelines is culturally sensitive 
psychotherapy. The EBPP guidelines also carefully 
FRQVLGHU�WKH�LQÁXHQFH�RI �HFRQRPLF�IDFWRUV��VR-
ciocultural factors, and situational factors on the 
mental/physical health of  a client (APA, 2006). 
Although the APA Task force of  2006 is a complex 
and comprehensive approach to evidence-based 
treatments and considerations for culturally diverse 

clients, the limitation of  this approach consists of  
the lack of  research that encompasses culturally 
PRGLÀHG�LQWHUYHQWLRQV�DQG�FXOWXUDO�VHQVLWLYLW\�WR�
ethnic minority and indigenous communities.       
 Healing With Indigenous people. In work-
ing with individuals who have various worldviews, 
such as indigenous populations, we need to acknowl-
edge healing from a different perspective. Indige-
nous healing takes a holistic outlook on well-being 
(Singh, 1999; Sue & Sue, 2002). Certain cultures at-
tribute mental illness, deviant behavior, or chronic 
ailments to spiritual or cultural origins (Harner, 1990; 
Sue & Sue, 1999; Lee & Armstrong, 1995). For ex-
ample, although alternative medicine is viewed as 
an alternative to natural science and medicine, it is 
not uncommon for certain cultural groups to view it 
as primary line of  treatment. Mestizo communities 
(indigenous Latino(a) origins) utilize plants, herbs, 
and medicinal teas for the treatment of  mental/
physical conditions through a curanderismo (spir-
itual healer) in their communities (Lara, 2008). In 
this regard, alternative medicinal treatments are not 
alternative at all to the healers and/or curanderos 
of  a mestizo community (Hernandez-Wolfe, 2011).  
 Some indigenous considerations have been cul-
tivated from work by Lee & Armstrong (1995), Sue 
& Sue (1999) and Helms and Cook (1999) in Yeh 
et al.’s (2004) review of  indigenous perspectives of  
healing. Although the review accounts for various 
counseling and research considerations, the most per-
tinent to counseling are as follows: (a) be open and 
aware to indigenous healers and forms of  healing, 
(b) reach out and connect with healers and incorpo-
rate their spiritual/healing beliefs into the therapeu-
tic alliance, (c) understand that indigenous healing is 
not goal oriented and does not focus on technique 
RU�TXDQWLÀFDWLRQ��$OWKRXJK� WKHVH�DUH�RQO\�D� IHZ�RI �
the listed considerations, they are not exclusive to the 
therapeutic alliance with indigenous populations. In 
order to fully encapsulate working with indigenous 
populations in research we will discuss research sug-
gestions that can be applicable to ethnic minority 
populations as well, in the research and clinical realm 
(e.g., Latino(a), indigenous populations, Mestizo).   

Culturally Relevant Applications in Research

ETHICAL RESEARCH WITH PEOPLE OF COLOR



78

 Many of  the recommendations that will be pro-
vided are similar to community-based participato-
ry research (CBPR); however, CBPR can mostly be 
found in public health research rather than social sci-
ence research (Flicker, Travers, Guta, Mcdonald, & 
Meagher, 2007).  This is not to say that this research 
method cannot make the transition to a more social 
science–based practice; however, it is vital to the au-
thors to make a clear distinction of  the themes more 
relevant to indigenous and ethnic minority commu-
nities in evidence-based practice research.  CBPR “. 
. . is an orientation to research that focuses on re-
lationships between academic and community part-
QHUV��ZLWK�SULQFLSOHV�RI �FR�OHDUQLQJ��PXWXDO�EHQHÀW��
and long-term commitment and incorporates com-
munity theories, participation, and practices into the 
research efforts” (Wallerstein & Duran, 2006, p. 312).   
Some of  the major challenges with CBPR include 
the participation of  the community members and 
the control behind the initiatives of  the researchers, 
and who has the primary control over the research 
process, data-collection, and data-dissemination. An-
other challenge is based on the community consent 
and who provides the approval in each community 
(Wallerstein & Duran, 2006).  CBPR is well estab-
lished in literature for empowering and improving 
communities.  However, it is important to note that 
the goals and outcomes of  the research should not 
be solely determined by the researchers and should 
be a collaborative process with the community.  Eth-
nocentric perspectives should not be forced upon the 
individuals of  ethnic minority backgrounds; rather 
researchers ought to work with the community to 
ensure that research is meeting the goals of  the com-
munity and are relative to their worldviews. Practice 
goals should be comparable to the goals of  the com-
munity.  One interesting recommendation provided 
in the CBPR research is that university-community 
partnerships should be developed (Wallerstein & 
Duran, 2006).  However, it is important to mention 
that this may be a challenge, with the lack of  high-
er educational institutions located in all communities 
of  ethnic minorities.  For example, in Hawai’i, it is 
GLIÀFXOW� IRU� FRPPXQLWLHV� WR� GHYHORS� UHODWLRQVKLSV�
with the university system as the main universities 
are located on the main island and many of  the in-

digenous communities are located on the outer is-
ODQGV���5HODWLRQVKLSV�FDQ�EH�GLIÀFXOW�WR�GHYHORS�EDVHG�
on travel time and costs, and cultural differences.  
 Another limitation is that the literature on CBPR 
does not show the effect of  interventions in commu-
nities once researchers/clinicians have left the com-
munities.  Much of  the literature found on CBPR is 
based on urban health care research (Minkler, 2005). 
With our focus being more on ethnic minorities and 
indigenous populations; the goals differ.  In an ur-
ban setting, it is a bit easier to access populations 
of  ethnic minorities, develop university-communi-
ty relations, and have research meetings.  In a more 
rural and culturally sensitive setting, more challeng-
es arise with the key components of  CBPR.  Rela-
tionships take time and effort to develop, with travel 
time and costs; urban-based research would be more 
HIÀFLHQW� WKDQ� UXUDO�EDVHG� UHVHDUFK�� 2XU� GLVFXVVLRQ�
will focus on more humble collaborative approach-
es that are stronger and longer, withstanding the 
limitations of  CBPR in order to establish longer 
and more salient relationships in the community.    

Research Implications for Indigenous and/or 
Ethnic Minorities 
 Developing Community Relationships. Due 
to previous injustices experienced by ethnic minori-
ties (e.g., discrimination) and previous mistrust of  
healthcare providers, it is vital that when services are 
provided they meet the needs of  the communities, 
families, and/or clients.  Most researchers and prac-
titioners are operating from a Western framework; 
thus, relationship development with ethnic minority 
patients and the indigenous community is the foun-
dation of  ethically sound research and practice. Fur-
thermore, building strong communal relationships 
that are more holistic, universal, and culturally sensi-
tive will ensure more successful implications of  clin-
ically competent research (Vicary & Bishop, 2005).
 Extra care should be taken to be involved in the 
community in which research and practice is execut-
ed. Cultivating social relations is vital in building re-
spect within the community (Darou, Hum, & Kurt-
QHVV�� ������� � 0RUH� VSHFLÀFDOO\�� EXLOGLQJ� VWURQJ� WLHV�
between community members and leaders in the re-
search process helps unite researcher and community 

SAN MIGUEL, MONIZ



79

through at a common framework. Since researchers 
and practitioners can be viewed as outsiders that do 
not fully understand the culture, this can create a 
barrier to accurate cultural insight. Without a deep 
XQGHUVWDQGLQJ�RI �WKH�FXOWXUH��UHVHDUFK�ÀQGLQJV�PD\�
QRW� EH� SUHVHQWHG� LQ� D�PDQQHU� WKDW� LV� � UHÁHFWLYH� RI �
the true nature of  minority ethnic or indigenous life. 
Uniting researcher with the community may also alle-
viate mistrust and help lessen fear associated with the 
experience of  discriminatory and exclusionary his-
tory. Understanding and respecting these hesitations 
is necessary in softening the negative perceptions of  
research in these communities. Researchers and prac-
titioners must gain a deeper understanding of  the his-
tories of  a community and its culture to ensure stron-
ger relationship development (Darou et al., 1993).
 Developing Advisory Boards. Developing ad-
visory boards among ethnic minority and indigenous 
communities to assist oversight of  research from 
initiation to completion can foster  trusting working 
relationships.  The objective of  these advisory boards 
would be to protect community values and its mem-
bers through meaningful culturally relevant research 
(Quinn, 2004). Advisory boards would consist of  
SURPLQHQW�FRPPXQLW\�PHPEHUV�ZKR�SOD\�VLJQLÀFDQW�
roles in the community, educational leaders, research-
ers with similar cultural backgrounds, and other rele-
vant advocates. By establishing a community council 
board, researchers are opening community conversa-
tion and considering the input directly from those who 
DUH�LPSDFWHG�E\�WKH�UHVHDUFK�SURMHFW�DQG�LWV�ÀQGLQJV���
Community advisory boards allow for a collaborative 
research relationship to develop between community 
members and researchers and continuous community 
engagement throughout the research process (Cana-
dian Institutes of  Health Research, 2010).  The com-
munity board would play an active role in establishing 
project completion and assist in contributing their 
perspective on the cultural issues being evaluated. 
Most importantly, the ethical responsibility would rely 
solely on the researcher regardless of  the prominent 
role the community advisory board plays (Darou et 
al., 1993). So we must keep in mind that research-
ers must establish this relationship while continuous-
ly maintaining ethically sound research in line with 
ethical review boards (e.g., Internal Review Board). 

 Identifying Community Leaders/Advocates. 
Although the strategy of  utilizing community lead-
HUV�LQ�WKH�UHVHDUFK�SURFHVV�LV�EHQHÀFLDO�IRU�DGHTXDWH�
representation, we must also emphasize the chal-
lenges associated with choosing the most appropri-
ate advocate for the community. For example, there 
is no direct leader or groups of  leaders in Hawai’i 
representing Native Hawaiians. So how would a re-
VHDUFKHU� VHHN� RXW� D� FRPPXQLW\� OHDGHU� WKDW� UHÁHFWV�
+DZDL·L� LQ�WKHLU�UHVHDUFK"�$�SRVVLEOH�SURSRVLWLRQ�WR�
this challenge is opening discussion with local his-
WRULFDO� DJHQFLHV�� VSHDNLQJ� ZLWK� SXEOLF� RIÀFLDOV�� DQG�
speaking to individuals in the community. Although 
this pursuit is more time consuming and takes a great 
quality of  effort, it contributes to an open and trust-
ing relationship with the people (Ball & Janyst, 2008; 
Schnarch, 2004).   The relationship built between the 
researchers and community should not be brushed 
over, as strong bonds are necessary to ensure cultur-
ally responsive research that may pave more oppor-
tunities for research to be conducted in the commu-
nity. Creating this new trusting relationship may aid 
some ethnic minority and indigenous communities 
to combat the injustices faced in history (Johnstone, 
������� � )XUWKHUPRUH�� UHVHDUFKHUV� FRXOG� ÀQG� ZD\V�
to show appreciation and gratitude to that commu-
nity for allowing them to enter their cultural space 
and not impinging on their values in order to con-
duct research (Ball & Janyst, 2008).  Understanding 
and showing an appreciation of  political structures 
in their communities is important to identify early in 
the relationship (Darou et al., 1993). This may pre-
vent any type of  power struggle that may arise. Ad-
ditionally, navigating through this understanding will 
help minimize the potential for exploitation or the 
appearance of  exploitation (Alvidrez & Areán, 2002).
 Focusing on Trust and Communication. Ac-
cording to a core principle of  the Tri-Council Policy 
Statement on ethical conduct for research involv-
ing humans, it is imperative for researchers to take 
time to establish relationships with the community 
in order to promote mutual trust and communica-
tion.  Developing relationships with the community 
FDQ�WDNH�D�VLJQLÀFDQW�DPRXQW�RI � WLPH��DQ�HVWLPDWHG�
timeframe for relationship development should be 
factored into a prospective research plan. This al-

ETHICAL RESEARCH WITH PEOPLE OF COLOR



80

lows the researcher and community to work com-
SDVVLRQDWHO\� LQ� WKH� LGHQWLÀFDWLRQ� RI �PXWXDOO\� EHQH-
ÀFLDO� UHVHDUFK� JRDOV� �&DQDGLDQ� ,QVWLWXWHV� RI �+HDOWK�
Research, 2010). Once relationships have been es-
tablished within the community, it is critical for a 
new researcher to slowly build a similar trusting re-
lationship and not attempt to acclimate too quickly. 
This process is necessary in order to maintain re-
lationships with the community (Schnarch, 2004).
 Sharing Data Results With the Community. 
Throughout the research process and at the end of  
the project, data-sharing sessions are important for 
participants, community members, and the advisory 
boards (Darou et al., 1993).  These data sharing ses-
sions allow for the community to gain a better under-
VWDQGLQJ�RI �ÀQGLQJV�UHODWHG�WR�WKH�SURMHFW�DQG�UHODWHG�
EHQHÀFLDO� RXWFRPHV�� � ,Q� FRQGXFWLQJ� D� VHVVLRQ�� WKH�
data should be presented in a general and simplistic 
procedure. The community should be aware of  the 
systematic approach to research in general and how 
WKH�ÀQGLQJV�ZLOO�EH� LQWHUSUHWHG��$�FKDOOHQJH� WR� WKLV�
approach includes the authority of  who owns the in-
formation (Schnarch, 2004).  During initial establish-
PHQW�RI �WKH�SURMHFW��UHVHDUFKHUV�VKRXOG�FOHDUO\�GHÀQH�
WKH�DXWKRUVKLS�RI �WKH�ÀQGLQJV�DV�ZHOO�FRPPXQLFDWH��
genuine appreciation for the sharing of  information 
by the community. Although it is probable that some 
may suggest ownership belongs to the people and the 
community and others may believe the researchers 
and academic institutions hold the rights to the infor-
mation, the common bond is the sharing of  accurate 
information. Another piece of  information should 
be discussed during the initial phases of  the research. 
The community should have an understanding of  
WKH�SRWHQWLDO�ÀQGLQJV�DQG�LPSOLFDWLRQV�IRU�WKH�FRP-
PXQLW\��$Q�H[DPSOH�RI �WKLV�ZRXOG�EH�LI �WKH�ÀQGLQJV�
show the community in a negative light by bringing 
shame to their identity or damaging cultural history. 
 Enriching Indigenous/Ethnic Minority 
Cultures. One component of  culturally sensitive 
research is not conducting research for the sake of  
conducting research but rather it is encompassing the 
well-being of  the participants and their community 
(Darou et al., 1993).  Research conducted in ethnic 
minority and indigenous communities should be 
with aspirations to revitalize and enrich the culture 

rather than to impose on the culture. Revitalization 
of  the culture includes identifying, promoting, and 
enhancing the strengths of  the community rath-
er than emphasizing weaknesses or shortcomings. 
Cultural comparisons and other biases should be 
carefully considered before initial publications or 
should be forthcoming in discussion. In other words, 
including issues in research that are not culturally 
relevant or congruent for them should be careful-
ly assessed and evaluated. One worldview, such as 
that of  a Western perspective, should not be held 
higher than another worldview (Darou et al., 1993).
 Addressing Language Barriers. In addition to, 
creating a community advisory board and including 
members from the community, researchers need to 
adequately address language barriers, if  there are any. 
Individuals from multiple language backgrounds may 
not understand the research material, test measure-
ments, or even the basic instructions needed to com-
plete a consent form if  these materials are not trans-
lated accurately in their native language.  To ensure 
maintenance of  recruitment and retention, research 
PHPEHUV�VKRXOG�EH�HLWKHU�SURÀFLHQW�LQ�WKH�ODQJXDJH�
PRVW� FRPPRQ� LQ� WKH� FRPPXQLW\� RU� ÀQG� VRPHRQH��
ZKR� KDV� SURÀFLHQF\� LQ� WKH� FRPPXQLW\·V� ODQJXDJH�
and comfortable with working in the community. 
 This critical point is also relevant for clinical 
practice (Lau, Chang, & Okazaki, 2010).  In the ef-
fort of  translating measures and content used in the 
research project, researchers should be attentive to 
cultural differences that may occur in direct language 
WUDQVODWLRQV��)RU�H[DPSOH��VRPH�FXOWXUHV�PD\�GHÀQH�
abstract concepts differently from those of  a West-
ern perspective or an ethnocentric concept, especially 
in regards to highly technical academic vocabulary.  
7KHVH�GLIÀFXOWLHV�DUH�HVSHFLDOO\�SUHYDOHQW�ZKHQ�WU\LQJ�
to translate research instruments and measures (Lau 
HW�DO�����������/DQJXDJH�PRGLÀFDWLRQV�VKRXOG�DOVR�EH�
aligned with treatment protocols. In general, cultural-
O\�ULFK�FOLHQWV�PD\�KDYH�GLIÀFXOW\�ZLWK�KLJK�ODQJXDJH�
(therapeutic jargon), and this language may be prob-
lematic if  not translated into laypersons vocabulary 
(Vicary & Bishop, 2005).  Being cognizant of  these 
possible limitations and language barriers is vital. 
0RUH� VSHFLÀFDOO\�� XVLQJ� DQ� DFFHVVLEOH� XVHU�IULHQGO\�
written consent form that only includes relevant in-

SAN MIGUEL, MONIZ



81

formation in conjunction with an oral consent com-
ponent may lessen possible language barriers (Mead-
ows et al., 2003).  Although these considerations are 
minuscule in scale, the effect is immeasurable for 
the ethnic minority and indigenous communities.

Conclusion

 Although the tasks to approach culturally sound 
and ethical practices in the application of  psycho-
therapy and in counseling research can be consid-
ered a large feat, the discussion of  the common 
threads is fundamental to the practices of  research-
ers and psychologists alike. In looking for answers 
on ethnic minority clinical treatment, we found a 
commonality of  values within indigenous popula-
WLRQV� WKDW� FRXOG� EHQHÀW� IURP� VLPLODU� DSSOLFDWLRQV��
Certain considerations should be evaluated for the 
XQLTXHQHVV� RI � WKH� FOLHQW� LQ� SV\FKRWKHUDS\�� VSHFLÀ-
cally evaluating indigenous practices and traditions 
as a source for mental and physical health. Although 
there is limited support for some conceptual frame-
works such as the MCC, it is not a sole framework 
with which to focus. Rather, in order to be cultur-
ally sound psychologists, we should have a dynamic 
framework that encompasses MCC, EBPP, and cul-
tural humility. Research is limited in cultural humility 
within counseling psychology practices, but it would 
be an interesting focus of  research for the future. 
 In regards to working with indigenous commu-
nities and ethnic minorities for data collection, it is 
imperative to focus on long-standing humble rela-
tionships. Although some frameworks are similar, 
such as CBPR, which originates in public health, are 
based primarily on the medical model,  as social sci-
ence researchers, our initiative is based on a more 
holistic and humanistic approach, commonly named 
the biopsychosocial model. So it would be interesting 
to see the applicability of  CBPR in the domain of  a 
biopsychosocial framework in social science research 
on indigenous and/or ethnic minority communities. 
 In appreciation of  cultural differences with 
ethnic minorities and/or indigenous communi-
ties, we recognize that as patients or as subjects in 
UHVHDUFK� WKH\� DUH� KXPDQ� ÀUVW� DQG� IRUHPRVW�� $OVR��
building cultural humility is vital in patient/ther-

apist interactions as well as being socially humble 
with these communities in research. If  we keep this 
in mind, we can further develop and progress as a 
counseling profession towards ethically sound and 
culturally relevant clinical and research practices.

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