Forensic psychology: Part 3: Chapter 6: Gender and cultural issues

Multicultural Competence: Theory and Practice for Correctional Psychologists

by Joseph E. Couture, Ph.D.^{Footnote 1}

As Canada's population continues to diversify, it becomes increasingly more important for psychologists to become sensitive to, and familiar with, different ethnic cultures. Indeed, given the large proportion of "culturally different" inmates in jails and prisons, it is important that psychologists working in those settings gain multicultural competence. Furthermore, given the over representation of aboriginal persons among inmates, it is critical that psychologists gain familiarity with the Native culture.

The current state of psychological study and research presents findings that are helpful for gaining some understanding and appreciation of inmates who are culturally different. Using the psychological research for background information, this chapter serves as a guide to the development of appropriate theory and approaches to Native Canadian assessment issues. Opening comments set the stage for a discussion of assumptions and guiding concepts and attitudes in assessment leading to a sub-section on Native assessment. Because of its central importance acculturation is examined next, followed by a discussion of the relevance and need for moderator variables. A final section describes some issues and developments related to Native inmates.

Experience indicates that Native Americans in general tend to underutilize mental health services. There may be a variety of explanations for this phenomenon. However, an underlying reason may be that the mental health system has traditionally been developed to meet the needs of persons in the dominant Anglo-North American society. The widespread perception among aboriginal people is that the mainstream mental health system remains ignorant of both cultural expectations for the appropriate delivery of service, and of cultural roles.

Indeed, many psychologists may operate on unexamined biases, incorrect assumptions, and insufficient information when working with clients or patients whose cultural backgrounds differ from their own.

Prevailing views also fail to perceive that Canadian Aboriginal cultures are not static but, rather, are in a profound state of flux. Further, at the present time many Native cultures are neither intact nor entirely healthy. Also unrecognized is that, historically, the Native world view is comprised of a number is distinct sub-groups with individual identities. Native people, as a group, generally have tended to resist the destruction of their unique world view. Dana (1993) states that there appears to be relatively greater factorial consistency across tribes, as well as a factorial pattern that is distinctively different from the Anglo- American pattern (p. 190). Dana's contribution to the literature cannot be overstated. Indeed, his book provides a useful source of information for clinicians, and is relied upon heavily in this chapter.

These Native behaviours have inhibited and minimized assimilation into Canadian society, and have enabled life to be sustained under degrading conditions of poverty, relative lack of educational opportunity, isolation, and sustained attempts to obliterate Native cultural groups. This situation is rendered more complex because of a subtle, overt, systemic racism that permeates North American society. For example, behavioural and cognitive differences tend to be attributed to genetic deficit, or to the effects of poverty and discrimination.

As the above discussion makes clear, a significant gap exists between the cultural backgrounds of aboriginal people, and the attitudes and expectations of those in the mental health system. To fill this gap responsibly, we must question both psychology's Anglo- American, male dominated model, as manifest in psychometric technology and the coherence and integrity of contemporary psychology. Prevailing social science attitudes affect the health and mental health services available to Native cultural groups. In the following section, I turn to a discussion of the assumptions that underlie the development of multicultural competence.

Both the assessment process and the diagnostic criteria for psychopathology are based, at least to some extent, on culturally formed professional judgments. As a result, therefore, the anticipated outcomes of assessment, which also are based on normative standards from the dominant culture, have limited utility for culturally different clients. Misdiagnosis, for example, may lead directly to the choice of inappropriate and ineffective choices of intervention. Therefore, careful attention must be paid to the assumptions that underlie the diagnostic and assessment process employed by psychologists.

This chapter attempts to examine those fundamental issues within the following framework of assumptions:

• that clinical assessment hinges on the process of systematically learning about a patient-incommunity;
• that cultural competence is a component of general clinical competence ;
• that inter-cultural competence is dependent on a style of service-delivery that is perceived by the consumer client and community as credible and giving, effective and trustworthy;
• that community insight, expectation, and influence is essential to the Native-related assessment enterprise;
• that service can be provided in keeping with traditional, core cultural standards ; that practitioners' proactive respect for others requires increased self-awareness of their own socialization, attitudes, biases, and the limitations of their knowledge and skills;
• that most Native Canadians are in cultural transition and are experiencing varying degrees of acculturation stress;
• that contemporary Native Canadian cultures and communities are greatly heterogeneous;
• that the cause of disorders is not assumed to be entirely within the individual, stemming from such things as definite disease-causing agents, genetic predisposition, brain chemistry, and/or early learning — nor exclusively subject to societal/environmental factors as the context of individual life experiences; and
• that Native mental health hinges on a sense of "embedded self" (i.e., of person-incommunity).

One of the underlying ethical principles of mental health professionals is a demonstration of competence (Ogloff, 1995). Indeed, Ethical Standard 11.6 of the Canadian Code of Ethics for Psychologists (1991) provides that "in adhering to the principles of Responsible Caring, psychologists would...offer to carry out (without supervision) only those activities for which they have established their competence to carry them out to the benefit of others." Thus, psychologists who work with culturally diverse populations have a duty to ensure that they develop multicultural competence.

Responsible clinical practice, which includes multicultural competence, requires:

• an awareness of the effects of the Anglo- Canadian world view and of different world views;
• cultural sensitization, including an understanding and appreciation of how the concept of "self' identity differs across cultures;
• the application of alternative models of science; and
• positive attitudes toward assessment theory and practice in a pluralistic society with its conflicting differences in world views.

As the work of Dana (1993) and others suggest, the development of multicultural competence, based on theory and method, can be approached systematically. This approach can enable psychologists to develop the skills necessary to deliver appropriate services to culturally diverse people generally, and to Canadian Aboriginals, in particular.

i) Awareness of differing world views

Group and individual identity are shaped by such interacting and interdependent variables as customs, values, beliefs and language. It is these components that contribute to people's perceptions of mental health services, service providers and service delivery. Therefore, it is important for psychologists to become aware of the ways in which the customs, values, and beliefs of multicultural groups differ from those of the dominant culture. Some specific features of the western world view are indicated in the following sections.

ii) Cultural sensitivity and the concept of self-identity

The prevailing western concept of self manifests as a self-contained individualism, or egocentrism, characterized by personal control and a self-concept that excludes other persons. There seems to be an unquestioning belief in the use of personal control, through the acquisition of money, power, recognition, and the drive to fashion an orderly world and satisfactory self-definition, through "making something of oneself."

In contrast, from a traditional viewpoint, Native people's self-identity is sociocentric, including extended relationships with others. As Dana (1993) describes, this augmented self is responsible and obligated to a variety of other persons who are affected by the individual's actions and have to be considered in all decision-making and problem-solving situations (p. 11).

As Dana's statement suggests, interactive boundaries are fluid between self and other persons in the extended family, in clans, and in the community. Indeed, among Native people, such a sociocentric sense of self provides contextualization and meaning to their lives. At one time, strong family and/or clan ties made possible the social controls that existed throughout life and shaped consciousness of the self. During earlier periods in many First Nations there was absolute control by the family over social behaviour and sexuality during all phases of life.

The power of family ties among First Nations people has diminished since the period of contact with European settlers. Family life has become more difficult to characterize. Although family infrastructure endures, family life and community life processes themselves are now increasingly uncertain. Traditional kinship boundaries are blurring. Yet the family remains, in Bea Medicine's words, as "an adaptive survival structure" (Dana, 1993, p. 81). She notes that more and more "the extended family refers to a village-type Native American community network in which responsibility is shared" (p. 81).

iii) Alternative models of science and the ascertainment of knowledge

The Western emphasis on individualism is germane within the mainstream concept of science, a twinning which bears markedly on the function of personal control and responsibility, and thereby on sense of self-esteem. In their need for cognitive certainty, psychologists, rooted in a self-contained individualism, tend to favour the attitudes, theories and methods of contemporary positivist, empiricist science.

The views and strategies that have been adopted by psychology include scientific values, determinism, objectivism, data, laboratory investigation, the historical, heredity, nomothesis, concrete mechanisms, elementarism, cognition, and reactivity. These strategies have influenced psychologists to believe that reliable and valid data are always obtained regardless of the cultural origin of the client, notwithstanding mounting evidence that diagnostic procedures may not be cross-culturally appropriate (see Greene, 1987; Triandis & Berry, 1980).

An alternative perspective to that which has been adopted by psychology requires a relatively sharper focus on subjective experiences. Along with a different focus, psychologists should consider alternative factors that may be more relevant to cross-cultural research and practice (e.g., values, indeterminism, intuitionism, theory, field study, the ahistorical, environment, idiography, abstract concepts, holism, affect, and creativity). The clashing of the traditional methods of science and psychology, and of those suggested to be more effective for multicultural populations, has serious implications for clients, diagnosis, assessment, and intervention.

A Western stance assumes that clients are essentially similar, are expected to aspire toward internal control and exercise personal responsibility in their own lives. Services for these mainstream clients constitute a contractual and negotiated exchange grounded in participants' exclusive responsibility for themselves. One result is that such expectations signal autonomous behaviour and essentially solitary identities as requisites. In contrast, traditional Native sense of self, defined in terms of others, may find a relentless focus on self as alien, disquieting, undesirable or unnecessary.

Just as culturally insensitive practices have implications for clients' needs, they too have significance for diagnosis specifically. Emotional and psychological problems are inadequately identified, if not obscured, and are at risk for misdiagnosis in accordance with a world view based on the dominant Anglo-Canadian culture. Even when outcomes of culturally unsophisticated assessment are not extreme, there is always the chance of confusing culture and psychopathology, of confounding psychopathology with generic deviance, where psychopathology includes both genuine and residual deviance. The latter comprises less functional behaviors, or those "problems-in-living" that are not necessarily pathological, but which derive from formal cultural experiences.

iv) Assessment theory and practice

As the analysis of concepts and attitudes that guide traditional psychology suggests, the clashing of approaches of the mainstream versus multicultural groups may well result in culturally insensitive - or incompetent - practice. Nowhere is this more evident than in the area of assessment theory and practice. Given the sheer scope of issues in this regard, the next section is devoted to a discussion of Native assessment issues and approaches.

This section presents a discussion of the necessary elements to be considered to conduct "culturally competent" clinical assessments of Native people. To that end, it is important to consider both etic and emic measures (see Dana, 1993). Such an undertaking requires the clinician to pay attention to clinical diagnosis, descriptions of personality, and problems-in-living.

i) Clinical diagnosis

Several observations are warranted here. Reliable distinctions are needed between psychopathology that occurs in the dominant society and those that may or may not be similarly perceived in terms of behaviours/symptoms and meanings in other cultures. Indeed, the concept of "severe disturbance' differs as a function of culture and experience. For example, Johnson and Johnson (1965) indicate that "depression" among the Standing Rock Sioux is more inclusive than the DSM-III category, and is described as a syndrome translated as `totally discouraged' (in Dana, 1993, p. 95).

This pattern is more complex than that of the DSM because it includes alcohol abuse, deprivation, nostalgic orientation to the past, probably preoccupation with thoughts of spirits, and death, thought travel to the spirit camp where dead relatives reside, possible active wish to join these relatives by willing death or threatening/committing suicide. Grieving and mourning seem to include not only feelings over loss of family members, but also feelings over an enduring sense of loss of the land and of sustained threat to a vastly changed way of life, including loss of language.

This syndrome illustrates a set of symptoms that, while culture-specific, also may be characteristic of other Great Plains groups. Considerations, such as those delineated in this example, must be considered for each of the major Native Canadian groups.

The depression example illustrates taxonomic need. It would be useful for the DSM to list the specific elements/considerations of a "cultural axis." The recent revision, DSM-IV (American Psychiatric Association, 1994), provides a very general discussion of cultural relevance in Appendix I. Dana (1993) suggests as an alternative to the DSM that the international classification of mental disorders developed by the World Health Organization be given consideration.

Other means to avoid the tendency to consider that diagnostic criteria are valid across cultural groups (referred to as the "cultural fallacy") are suggested by Marsella (1978) and Dana (1993). These involve reference to emic categories developed by using ethnoscience methodology, baseline, and interrelationship data for frequency, intensity, and duration. On the basis of such preliminary data, objective symptom patterns can be established through application of multivariate techniques.

ii) Descriptions of personality

Just as clinical diagnosis presents unique considerations to perform culturally competent assessments, so does descriptions of personality. When considering personality, both content and process issues need to be addressed. Content issues bear on discrete personality constructs and/or global personality theories. When possible, clinicians must avoid confounding culture and personality. Once again, the same constructs are not necessarily expressed similarly across different languages and cultures. Even if the same construct does exist, it does not necessarily have the same meaning from one culture to another. Translation difficulties are a significant clue to a lack of construct equivalence.

Aside from language difficulties, world-view differences lead to variation in the boundaries of the self-concept, in the desirability of certain value orientations, in the conceptualizations of phenomena, and in feelings of personal control and responsibility for one's own behaviour. An adequate selection of culturally relevant personality descriptions would account for the influence of individual living context (i.e., the functionality of characteristics and behaviors relative to coping with life events, problem-solving relative to survival, adaptation, and personal well-being).

Once again, (mis)interpretation of behaviour and cognitions is an issue in multicultural assessments because it may lead to assessor bias. Bias exists relative to dominant cultural beliefs in assimilation, the use of Anglo-centric theory and methods, and in stereotyped expectations regarding minority group behaviors. Bias is expressed in the form of "deficit" hypothesis that now includes "cultural deprivation" and "social pathology" (Mays, 1985). Bias also is found in a tendency towards assuming greater similarity than dissimilarity between or among culturally diverse groups.

An illustration of the "cultural similarity" tendency is found in the routine use of the Minnesota Multiphasic Personality Inventory (MMPI), and now the MMPI-II, with Native patients or clients (see Greene, 1987; Pollack & Shore, 1980; Whatley & Dana, 1989). Some of the underlying problems of the MMPI and the MMPI-II, with respect to multicultural assessment, occur as a result of the way in which it was empirically derived. As Dana (1993) writes, "the empirical item selection procedures used, in both versions of the MMPI...were deliberately unrelated to item content in predominantly North American standardization samples" (p. 99).

Research comparing the validity of MMPI scores and profiles of people in the dominant population with Native people further highlights some of its limitations. For example, the work of Pollack and Shore indicates, regardless of diagnosis, that Northwest Indians consistently obtain significant elevations on the "fake good," psychopathic deviate, and schizophrenia scales. Wormith (1984) reported similar findings in a comparative study of the MMPI profiles of Native and non-Native inmates.

As one might anticipate based on the earlier discussion of the differences in Native people's self-concept or identity, Native people may be mislabelled as suffering from Dependent Personality Disorder and Paranoid Personality Disorder. DSM descriptive criteria for Dependent Personality Disorder includes granting to others responsibility for one's own major life decisions and subordination of personal needs to those of others. As discussed more fully above, in many Native cultures, responsibility is assumed by others, because self-concept places some responsibilities on designated family members, and not because the individual is incapable of functioning independently.

Not only does culturally competent assessment require addressing issues of content, such as those just discussed, but we must also consider issues of process. As Dana (1993) writes, culturally competent assessment techniques without concomitant use of culturally acceptable style of service delivery cannot yield valid personality/ psychopathology finds, in spite of the good intentions of Anglo-American assessors who may be kind, warm, well-meaning, and accepting of other persons (p. 107).

As this quote makes dear, clinicians who wish to obtain cultural competence must adopt delivery techniques that reflect an appreciation and understanding of the Native world-view. Getting to know the culture requires obtaining familiarity with Native people in their own settings. Also useful is some in service training in a Native Studies program, for example, by studying the language, healing practices, philosophy and tribal law.

iii) Problems in living

An important reason for establishing base rates for disorder in different cultural settings follows from the possibility that no dear distinction exists between specific pathological disorders and residual deviance. The DSM does provide general information for different cultural groups concerning the presence and prevalence of specific problems-in-living, when such information is available (e.g., alcohol and drug abuse, antisocial behaviour, anxiety, damaged sense of self, depression, difficulties in human relationships, physical violence, and emotional violence). But, as already noted, these psychopathologies can and do have different meanings and/or different risk factors for different cultural populations in different settings.

A number of additional problems-in-living can be identified for members of multicultural groups. For example, culturally different people may endure acculturation stress, which may comprise cultural confusion, damage as a result of racism by members of the dominant society, and deficits in skills required for functioning in the dominant society. Thus, in conducting assessments with culturally different people, attention must be paid to the extent to which problems-in-living may or may not bear special consideration.

Acculturation is the phenomenon of changes in original cultural patterns of groups who are in continuous first hand contact with one another. When one group is in a minority position relative to a second group, the pressure to change produces acculturation stress. Since the time of contact with European settlers, virtually all Native People have been — and continue to be — in cultural transition. This is certainly true at the present time, particularly because Native People have had to struggle to form a bicultural identity. In fact, an American survey found that most Natives identify to some extent with their traditional culture, but fewer than nine percent become assimilated (Johns & Lashley, 1989).

New forms of stress appear when multicultural groups come into contact with dominant groups, increasing subsequent phases of conflict and crisis. During crisis and attempted adaption, stress erupts, resulting in high rates of homicide, suicide, family violence, and substance abuse. Presently, there are three recognized states and phases or levels of acculturation: (a) traditionality; (b) marginality; and (c) assimilation. Several recently developed classification models exist (Dana, 1993; Red Horse, 1980a, 1980b; Waldram, 1992). No one of these three models address all acculturation characteristics and outcomes. Further work might address the phenomena of bicultural transition, pancultural transition and of "core culture" factors. Furthermore, attention should be paid to the influence of parental gender in mixed-blood relationships, and the retention of traditional culture by urban Natives.

Acculturation levels may affect the nature and form of the symptoms, client understanding of symptom origins, the expression of complaints, and reaction to intervention. Similarly, information regarding the level of acculturation in light of treatment philosophy, psychotherapy styles, and community interventions should be considered.

As always, acculturation concerns among Native people are compounded due to the large number of distinct tribal groups, with different acculturation histories and outcomes. Of special note is the realization that a Native person can live his or her entire life in a city and remain as traditional in cultural orientation as reserve Natives.

Based on the information provided here, the measurement of acculturation becomes a requisite in psychological assessments. This is based on the premise that culture does influence psychological test performance, and becomes all the more important since assessment evidence emphasizes group differences, rather than within-group variation. This point is important because within-group differences are greater than differences between groups (Argyle, 1969).

A challenge that presents itself when conducting multicultural assessments is to develop descriptions of factors and variables that moderate the acculturation process. Although this is a limited approach, given the tendency to minimize group differences, use of such measures can alert assessors to norm inadequacy and to the need to modify or qualify data interpretation. Dana (1993) states that the application of moderator variables may provide the only defensible rationale for continuing to use imposed etic measures for populations that are culturally different from standardization populations (p. 22).

Indeed, tests developed in one culture may be used with culturally different populations if new culturespecific norms are developed. To do that, the definition of "culturally different" and "moderator variables" must be clarified. To that end, application of the concepts of etic and emic measures is useful.

i) Etic versus emic

Etic measures are those that have been developed for use with the traditional, or mainstream, population. Typically, the psychometric properties of these measures are validated using the general population, or some sub-group of that population (e.g., inmates who are white males). On the other hand, emic measures are those that have developed over time to take into account the unique qualities and concerns of specific multicultural groups. Generally speaking, the assessment instruments available in North America have not been developed or adapted for use with multicultural populations. Instead of developing emic measures that are unique to — and valid for use with — a specific cultural group, the use of etic measures dominate mainstream practice in psychology. Indeed, many psychologists have assumed, in error, that assessment measures designed for use in the mainstream European or North American cultures are universally and cross-culturally valid (Berry, Poortinga, Segall, & Dasen, 1992; Irvine & Carroll, 1980).

The development of emic measures takes considerable time and appreciation of the cultures and, therefore, is a long term goal. While that process is greatly needed, more immediate steps should be taken to ensure that the results of assessments using traditional instruments are valid. In the short-term, then, a recommended focus is to identify those moderator variables that are characteristic of Native acculturation processes. These moderator variables will be useful for determining the extent to which individual acculturation in the dominant society occurs, and the extent to which use of traditional assessment practices are valid. These measures, or estimates, will be useful in indicating the degree that the original culture remains intact, as well as the degree to which the dominant society's values and behaviors are adopted. Given that the traditional and bicultural acculturation process for Natives are now acknowledged as being more complex than previously thought, the identification of these moderator variables is much more complex that originally contemplated (Dana, 1993).

ii) Research issues: Adapting European and American assessments for use with multicultural groups

In this section, attention is paid to the research issues that must be addressed to adapt traditional assessment measures for use with multicultural populations.

Construct related concerns

Any adaptation of assessment measures for use with multicultural populations must result in measures that are equivalent to the original measure. First, the adaptation must ensure construct equivalence. This includes ensuring that the constructs measured continue to be valid with the multicultural group. Similarly, any translations must be accurate, unique cultural response sets must be evaluated, and the multicultural patient or client's likelihood to self-disclose must be considered. For example, Native people may be more reluctant than others to discuss family relations or sexuality, other than in the context of particular relationships, especially in intimate or extended family settings. Factor analysis may be a useful technique for establishing whether factors on the adapted measures correspond closely to those factors that emerged from the original measure.

Next, care must be taken to determine whether the adapted measures are functionally equivalent to the original ones. For example, does the measure take into account different behaviors that may have developed in a multicultural group to cope with similar problems that occur in different cultural contexts.

Finally, the adapted forms of measures must have an equivalent "metric" or scale. For example, the formats for presentation of scales, questionnaires, and personality measures must be equivalent to the original measures. Contemporary formats of measures become an issue for non-literate persons and for those who do not speak the dominant language well. Translations are difficult and, even when equivalent constructs exist in another culture, a common problem is the failure to document the intensity, commonality, and range of use, in addition to the denotative meaning of constructs. For example, the English "yes" in the Algonquian language means "yes, maybe"; "no" becomes "no, maybe."

The need for both etic and emic measures
Both etic and emic measures are essential levels of analysis to counter the prevailing tendency to supplement an etic theoretical framework by an exclusively etic methodology (Irvine & Carroll, 1980). Again, both etic and emic measures and approaches are required for personality description, identification of problems-in-living, and diagnosis of psychopathology. The question becomes, then, how imposed etics may be used. It seems possible, as Dana (1993) indicates, to establish points on an etic/ imposed etic versus emic continuum of measures through careful and accurate translations, revised and more inclusive or culturally specific norms for standard instruments, emic adaptations of etic measures, and the development of new emic measures.

Emic emphasis

Emic measures are, by definition, culturally relevant and culturally specific. Emic methods include a variety of strategies such as matching, content analysis of the frequencies of associated ideas in verbal material (i.e., personal structure analysis, individualized questionnaires based on extensive interviewing of one person, essential characteristics or major structural foci in a life, self-anchoring scales, and peak experiences). Quantitative emic strategies include single-case experimental designs, ipsative ordering of responses to provide for intraindividual comparisons, and inverse factor analysis to identify major dimensions of individual personality.

Eventually, comparative studies using culturally relevant definitions may be completed. As Dana writes, "the development of culture-specific population databases by using emic strategies constitutes a necessary prerequisite to cross-cultural comparisons" (p. 94). The focus of a number of emic approaches is on social categories for thinking about the self and decision-making with regard to behaviour. Such data will lead to working hypotheses that may be tested and revised (see Medicine, 1980 and Trimble, Manson, Dinges, & Medicine, 1984, for examples of methods that are useful for use with Native people).

Given the present paucity of theory and research regarding psychological assessment and intervention with Native people generally, it should come as little surprise that the issue of Native sensitive approaches regarding Native inmates is very problematic. In North America, generally, and Canada, specifically, the necessary basic practice-oriented research has yet to be undertaken. More accurate and reliable diagnostic information about Native inmate behaviour is increasingly desired. The need for culturally-relevant and culturally-specific personality descriptions for psychopathology, including personality disorders, is obvious. A first step, as described above, is to discern and describe those key variables or factors in the acculturation process (i.e., the moderator variables). Secondly, research might also fruitfully bear on core cultural behaviors (i.e., those behaviors that are common to First Nations persons), as the criterion against which to assess the validity of existing measures, or to develop new, more valid and reliable, measures and methods.

Pending research development, I have been developing an approach to culturally-competent assessments with Native inmates (Couture, 1993). My present approach combines etic and emic measures and approaches as well as nomothetic and idiographic methods of assessment. Without the presence of research results, it is difficult to select measures that are valid for assessments of Native inmates. Unfortunately, I have had to rely primarily upon face validity as the criterion for test selection. For example, I have found that some measures appear to measure social interaction and self-assessment better in Native people than other measures (e.g., POI, FIRO-B). This may be attributed to criterion concepts of interpersonal orientation and self-actualization, respectively. Indeed, a conceptual relationship appears to exist between inner-directedness of the POT and the FIROB with the cultural principle of personal responsibility, and between general views on interpersonal relationships and traditional Native mutuality. Furthermore, the recent introduction of Progoff exercises (Progoff, 1992) into the assessment design seems to facilitate self-disclosure.

In addition to considering the results of measures that appear to be valid with Native inmate, I also find that observing men during traditional moments, such as dance, song, naming, colour giving, dreams, is useful as an indication of their level of emotional, mental, and spiritual maturation. The same holds true for observing the men during traditional Purification Ceremonies (e.g., sweetgrass and sweat lodge ceremonies). My assumption, albeit untested systematically, is that the participant responds in a significant way to the "safety" of the traditional moment or activity, and is thereby likely to exhibit "truer" behaviour (i.e., less defensive, less minimizing, and less angry).

As this chapter makes clear, extreme caution must be used when conducting psychological assessments with Native persons. The development of multicultural competence is both useful and necessary. The development of multicultural competence, including culturally sensitive diagnosis, however, is not a question of simply throwing out the constructs and tools psychologists have developed within Western culture. Rather, a pressing first step is to extend and enrich those methods and measures that exist, and to adjust and correct them through a fresh application of contemporary psychology's own principles and methods, to the unique personal qualities, experiences, and situations of First Nations people, including Native inmates.

While it is important not to overlook those advances that have been made in psychological assessment and evaluation, the success of investigating the validity of existing methods and measures for use with Native people is predicated upon actively questioning — indeed challenging — the values and assumptions that underlie the contemporary techniques and measures employed in psychological assessment. Such an open process of questioning and challenging existing methods and measures is crucial if advances are to be made in the area of specific (emic) assessment technologies for multicultural professional practice. To further this goal, a preliminary first step is to determine the acculturation processes and the related moderator variables that affect the process. This would require establishing a knowledge base derived from a careful review of research literature and of policy making with linkages to existing networks within minority communities (i.e., in community, local, provincial, and national contexts via boards, advisory committees, commissions, and task forces).

While existing methods and practices have significant limitations for use within Native culture, the reality is that we must continue to conduct assessments both for the benefit of the Native person, per se, but also for the purposes related to correctional management. As recommended in this chapter, therefore, in the short-term a sensible assessment strategy requires us to explore and define the unsuspected complexities of acculturation. To that end, measures that are employed for assessment must be carefully evaluated for use with Native people. Comparative studies and factor analyses of raw MMPI-2 scores, and other assessment scores, for Native and non-Native inmates may be useful for determining the utility of these measures.

Regardless of which measures or methods are currently used, the systematic and comprehensive investigation of existing and new measures and methods is key to ensuring that our multicultural assessments are valid and reliable. Competent, ethical, practice can settle for nothing less.

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