Psychology, Interamerican
Examining basic helping skills in cross-cultural counseling in the U.S.

How to Cite

Conoley, C., Morgan Consoli, M. L., Zetzer, H., Hernandez, E., & Hernandez, R. (2016). Examining basic helping skills in cross-cultural counseling in the U.S. Revista Interamericana De Psicología/Interamerican Journal of Psychology, 49(3).


We address the need for culturally informed counseling skills by using a multiple case study design that evaluates the basic helping skills with four volunteer Mexican American clients and four European American counselors in the U.S. While viewing vignettes of each skill used in their counseling session, four clients responded to written measures and verbal interview questions immediately after each of their three sessions. A mixed methods (QUAL + QUAN) analyses of verbal and written client assessments of the skills yielded converging results revealing variability in the perceived helpfulness of the skills. The concern regarding being understood by the counselor (i.e. empathy) was the most important criteria used by the clients to judge the skills. Feeling understood was most enhanced by the skills of restatement and immediacy. The most negatively rated skills were challenge, closed questions, information giving and direct guidance. Recommendations for future research and practice are discussed.


Andresen, E.M. Malmgren, J.A., Carter, W.B., Patrick, D.L. (1994). Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). American Journal of Preventive Medicine, 10, 77–84.

Arredondo, P., Gallardo-Cooper, M., Delgado-Romero, E. A., & Zapata, A. L. (2014). Culturally responsive counseling with Latinas/os. New York, NY: John Wiley & Sons.

Barak, A., & LaCrosse, M.B. (1975). Multidimensional perception of counselor behavior. Journal of Counseling Psychology, 22, 471-476. doi: 10.1037/0022-0167.22.6.471

Borrego, R. L., Chavez, E. L., Titley, R. W. (1982). Effect of counselor technique on Mexican-American and Anglo American self-disclosure and counselor perception. Journal of Counseling Psychology, 29, 538-541. doi: 10.1037/0022-0167.29.5.538

Boulton, M.J., Trueman, M., & Rotenberg, K. (2007). User perception of process – outcome linkages in pupil peer counseling for bullying services in the UK. British Journal of Guidance and Counselling, 35, 175-187.

Boyatzis, R.E. (1998). Transforming qualitative information: Thematic analysis and code development. Thousand Oaks, CA: Sage.

Bruce, M. L., Takeuchi, D. T.,&Leaf, P. J. (1991). Poverty and psychiatric status: Longitudinal evidence from the New Haven Epidemiologic Catchment Area Study. Archives of General Psychiatry, 48, 470–474. doi: 10.1001/archpsyc.1991.01810290082015

Burkard, A. W., Knox, S., Groen, M., Perez, M., & Hess, S. A. (2006). European American therapist self-disclosure in cross-cultural counseling. Journal of Counseling Psychology, 53, 15-25. doi: 10.1037/0022-0167.53.1.15

Cabassa, L. J., Zayas, L. H., & Hansen, M. C. (2006). Latino adults’ access to mental health care: A review of epidemiological studies. Administration and Policy in Mental Health and Mental Health Services Research, 33, 316–330.

Calderón-Tena, C. O., Knight, G. P., & Carlo, G. (2011). The socialization of prosocial behavioral tendencies among Mexican American adolescents: The role of familism values. Cultural Diversity and Ethnic Minority Psychology, 17, 98. doi: 10.1037/a0021825

Cardemil, E. V., Adams, S. T., Calista, J. L., Connell, Encarnación, J., Esparza, N. K., . . . Wang, E. (2007). The Latino mental health project: A local mental health needs assessment. Administration and Policy in Mental Health and Mental Health Services Research, 34, 331–341. doi: 10.1007/s10488-007-0113-3

Carkhuff, R. R. (1969). Human and helping relations (Vol. 1). New York, NY: Holt, Rinehart & Winston.

Castillo, L. G., Conoley, C. W., & Brossart, D. F. (2004). Acculturation, white marginalization, and family support as predictors of perceived distress in Mexican American female college students. Journal of Counseling Psychology, 51, 151-157. doi: 10.1037/0022-0167.51.2.151

Cecero, J. J., Fenton, L. R., Frankforter, T. L., Nich, C., & Carroll, K. M. (2001). Focus on therapeutic alliance: The psychometric properties of six measures across three treatments. Psychotherapy: Theory, Research, Practice, Training, 38, 1-11. doi: 10.1037/0033-3204.38.1.1

Chang, S. F., & Berk, A. (2009). Making cross-racial therapy work: A phenomenological study of client’s experiences of cross-racial therapy. Journal of Counseling Psychology, 56, 521-536. doi: 10.1037/a0016905

Cherbosque, J. (1987). Differences between Mexican and American clients in expectations about psychological counseling. Journal of Multicultural Counseling and Development, 15, 110-114. doi: 10.1002/j.2161-1912.1987.tb00385.x

Cherbosque, J. (1987b). Differential effects of counselor self-disclosure statements on perception of the counselor and willingness to disclose: A cross-cultural study. Psychotherapy: Theory, Research, Practice, Training, 24, 434-437. doi: 10.1037/h0085736

Creswell, J. W. (2012). Qualitative inquiry & research design: Choosing among five approaches (3rd ed.). Thousand Oaks, CA: Sage Publications

Cuellar, I., Arnold, B. & Gonzalez, G. (1995). Cognitive referents of acculturation: Assessment of cultural constructs in Mexican Americans. Journal of Community Psychology, 23, 339-356. doi: 10.1002/1520-6629(199510)23:4%3C339::AID-JCOP2290230406%3E3.0.CO;2-7

Cuellar, I, Arnold, B, Maldonado, R. (1995). Acculturation Rating Scale for Mexican Americans-II: A revision of the original ARSMA Scale. Hispanic Journal of Behavioral Sciences, 17, 275-304. doi: 10.1177/07399863950173001

Dewell, J. A., & Owen, J. (2015). Addressing mental health disparities with Asian American clients: Examining the generalizability of the common factors model. Journal of Counseling & Development, 93, 80-87. doi: 10.1002/j.1556-6676.2015.00183.x

Downs, F. & Eisenberg, D. (2012). Help seeking and treatment use among suicidal college students. Journal of American College Health, 60, 104–114. doi: 10.1080/07448481.2011.619611

Elliott, R., & Wexler, M. M. (1994). Measuring the impact of sessions in process-experiential therapy of depression: The Session Impacts Scale. Journal of Counseling Psychology, 41, 166-174.

Epperson, D. L., & Pecnik, J. A. (1985). Counselor rating Form—Short version: Further validation and comparison to the long form. Journal of Counseling Psychology, 32(1), 143-146. doi: 10.1037/0022-0167.32.1.143

Falicov, C. (1984). Therapeutic Strategies for Mexican-American families. International Journal of Family Therapy, 6. 18-30.

Flores, L. Y., Ojeda, L., Huang, Y., Gee, D., & Lee, S. (2006). The relation of acculturation, problem solving appraisal, and career decision-making self-efficacy to Mexican American high school students’ educational goals. Journal of Counseling Psychology, 53, 260-266.

Hanson, W. E., Curry, K., & Bandalos, D. (2002). Reliability generalization of Working Alliance Inventory scale scores. Educational and Psychological Measurement, 62, 659-673. doi: 10.1177/0013164402062004008

Hefele, T. J., & Hurst, M. W. (1972). Interpersonal skill measurement: Precision, validity and utility. The Counseling Psychologist, 3, 62-70. doi: 10.1177/001100007200300309

Heppner, P.P., Cooper, C., Mulholland, A., & Wei, M. (2001). A brief, multidimensional, problem-solving psychotherapy outcome measure. Journal of Counseling Psychology, 48, 330-343. doi: 10.1037/0022-0167.48.3.330

Hill, C. E. (2004). Helping skills: Facilitating exploration, insight, and action (2nd ed.). Washington, DC: American Psychological Association.

Hill, C. E. (2014). Putting it all together: Working with clients in the three-stage model. Helping skills: Facilitating exploration, insight, and action (3rd ed.). Washington, DC: American Psychological Association. doi:10.1037/14345-019

Hill, C. Baumann, E., Shafran, N., Gupta, S., Morrison, A., Rojas, A. E. P., Spangler, P. T., Griffin, S., Pappa, & Gelso, C. J. (2015). Is training effective: A study of counseling psychology doctoral trainees in a Psychodynamic/Interpersonal training clinic. Journal of Counseling Psychology, 62, 184-201. doi: 10.1037/cou0000053

Hill, C. E., & Knox, S. (2013). Training and supervision in psychotherapy: Evidence for effective practice. In M. J. Lambert (Ed.), Handbook of Psychotherapy and Behavior Change (6th ed., pp. 775-811). New York, NY: John Wiley & Sons.

Hill, C. E., & Lent, R. W. (2006). A narrative and meta-analytic review of helping skills training: Time to revive a dormant area of inquiry. Psychotherapy: Theory, Research, Practice, Training, 43, 154-172. doi: 10.1037/0033-3204.43.2.154.

Hill, C. E., Roffman, M., Stahl, J., Friedman, S., Hummel, A., Wallace, C. (2008). Helping skills training for undergraduates: Outcomes and prediction of outcomes. Journal of Counseling Psychology, 55, 359-370. doi: 10.1037/0022-0167.55.3.359

Hill, C. E., Spangler, P. T., Chui, H., & Jackson, J. L. (2014). Training undergraduate students to use insight skills: Overview of the rationale, methods, and analyses for three studies. The Counseling Psychologist, 42(6), 702-728. doi: 10.1177/0011000014542598

Hill, C. E., Stahl, J., Roffman, M. (2007). Training novice psychotherapists: Helping skills and beyond.

Psychotherapy: Theory, Research, Practice, and Training, 44, 364-370. doi: 10.1037/0033-3204.44.4.364

Hipolito-Delgado, C., & Mann, J. (2012). Illuminating the shadows: Sociopolitical and counseling needs of undocumented Mexican immigrants. Revista Interamericana de Psicología, 46, 395-402.

Horvath, A.O. & Greenberg, L.S. (1989). Development and validation of the working alliance inventory. Journal of Counseling Psychology, 36, 223-233. doi: 10.1037/0022-0167.36.2.223

Jones, N., & Mortimer, A. (2014). Measuring acculturation with the ARSMA-II: Bidimensional analysis increases accuracy as frequency of use increases over time. Hispanic Journal of Behavioral Sciences, 36, 387-412. doi:10.1177/0739986314548025

Kearney, L. K., Draper, M., & Barón, A. (2005). Counseling utilization by ethnic minority college students. Cultural Diversity and Ethnic Minority Psychology, 11, 272–285. doi: 10.1037/1099-9809.11.3.272

Kim, B. S. K., Hill, C. E., Gelso, C. J., Goates, M. K., Asay, P. A., & Harbin, J. M. (2003). Counselor self-disclosure, East Asian American client adherence to Asian cultural values, and counseling process. Journal of Counseling Psychology, 50, 324-332. doi: 10.1037/0022-0167.50.3.324

Kim, B. S. K., Ng, G. F., & Ann, A. J. (2009). Client adherence to Asian cultural values, common factors in counseling, and session outcome with Asian American clients at a university counseling center. Journal of Counseling & Development, 87, 131-142. doi: 10.1002/j.1556-6678.2009.tb00560.x

Kouyoumdijan, H., Zamboanga, B. L., Hansen, D. J. (2003). Barriers to community mental health services for Latinos: Treatment considerations. Clinical Psychology: Science and Practice, 10, 394-422. doi: 10.1093/clipsy.bpg041

LaCrosse, M.B. (1980). Perceived counselor social influence and counseling outcomes: Validity of the Counselor Rating Form. Journal of Counseling Psychology, 27, 320-327. doi: 10.1037/0022-0167.27.4.320

LaCrosse, M.B., & Barak, A. (1976). Differential perception of counselor behavior. Journal of Counseling Psychology, 23, 170-172. doi: 10.1037/0022-0167.23.2.170

LaFromboise, T.D., Coleman, H.D., & Hernandez, A. (1991). Development and factor structure of the Cross-Cultural Counseling Inventory-Revised. Professional Psychology: Research & Practice, 22, 380-388. doi: 10.1037/0735-7028.22.5.380

Lee, C. C. (Ed.). (2014). Multicultural issues in counseling: New approaches to diversity. New York, NY: John Wiley & Sons.

Li, L. C., Kim, B. S. K. (2004). Effects of counseling style and client adherence to Asian cultural values on counseling process with Asian American college students. Journal of Counseling Psychology, 51, 158-167. doi: 10.1037/0022-0167.51.2.158

Lorenzo-Blanco, E. I., & Delva, J. (2012). Examining lifetime episodes of sadness, help seeking, and perceived treatment helpfulness among U.S. Latino/as. Community Mental Health Journal, 48, 611– 626. doi: 10.1007/s10597-011-9426-5

Mills, M. L. (2012). Unconventional mental health treatment: Reexamining the racial-ethnic disparity in treatment-seeking behavior. Psychiatric Services, 63, 142–146. doi:10.1176/

Matarazzo, R. G. (1971). The systematic study of learning psychotherapeutic skills. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of Psychotherapy and Behavior Change: An Empirical Analysis (pp. 895–924). New York: Wiley.

Matarazzo, R. G. (1978). Research on the teaching and learning of psychotherapeutic skills. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of Psychotherapy and Behavior Change: An Empirical Analysis (2nd ed., pp. 921–966). New York: Wiley.

Mendelson, T., Rehkopf, D. H., Kubzansky, L. D. (2008). Depression among Latinos in the United States: A metaanalytic review. Journal of Consulting and Clinical Psychology, 76, 355–366. doi: 10.1037/0022-006X.76.3.355

Miranda, J., Azocar, F., Organista, K. C., Munoz, R. F., & Lieberman, A. (1996). Recruiting and

retaining low-income Latinos in psychotherapy research. Journal of Consulting and Clinical Psychology, 64, 868-874. doi: 10.1037/0022-006X.64.5.868

Morse, J.M. (2003). Principles of mixed methods and multimethod research design. In. A. Tashakkori & C. Teddlie (Eds.), Handbook of mixed methods in social and behavioral research (pp. 189-208). Thousand Oaks, CA: Sage Publications.

Ojeda, L., Castillo, L. G., Meza, R. R., & Piña-Watson, B. (2014). Mexican Americans in higher education: Cultural adaptation and marginalization as predictors of college persistence intentions and life satisfaction. Journal of Hispanic Higher Education, 13, 3-14. doi:10.1177/1538192713498899

Organista, P. B., Organista, K. C., & Kurasaki, K. (2003). The relationship between acculturation and ethnic minority health. In K. M. Chun, P. Balls Organista, & G. Marin (Eds.), Acculturation: Advances in theory, measurement, and applied research (pp. 139–161). Washington, DC: American Psychological Association.

Orozco, R., Borges, G., Medina-Mora, M. E., Aguilar-Gaxiola, S., & Breslau, J. (2013). A cross-national study of prevalence of mental disorders, service use, and adequacy of treatment among Mexican and Mexican American populations. American Journal of Public Health, 103, 1610-1618. doi: 10.2105/AJPH.2012.301169.

Priester, P. E., Jones, J. E., Jackson-Bailey, C., Jana-Masri, A., Jordan, E. X., & Metz, A. J. (2008). An analysis of content and instructional strategies in multicultural counseling courses. Journal of Multicultural Counseling and Development, 36 29-39. doi:10.1002/j.2161-1912.2008.tb00067.x

Paniagua, F. A. (2005). Assessing and treating culturally diverse clients: A practical guide. Thousand Oaks: Sage Publications.

Paul, G. (1967). Strategy of outcome research in psychotherapy. Journal of Consulting Psychology, 31, 109–118. doi: 10.1037/h0024436

Pedersen, P. B., Lonner, W. J., Draguns, G., Trimble, J. E., & Scharron-del Rio, M. R. (2015). Counseling across cultures. Sage Publications.

Ponterotto, J. G., Mathew, J., & Raughley, B. (2013). The value of mixed methods designs to social justice research in counseling and psychology. Journal for Social Action in Counseling and Psychology, 5(2), 42-68.

Prieto, L. R., McNeill, B. W., Walls, R. G., & Gómez, S. P. (2001). Chicanas/os and mental health services: An overview of utilization, counselor preference, and assessment issues. The Counseling Psychologist, 29, 18 –54. doi:10.1177/0011000001291002

Radloff, L.S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401. doi: 10.1177/014662167700100306

Ramos-Sánchez, L. (2009). Counselor bilingual ability, counselor ethnicity, acculturation, and Mexican Americans' perceived counselor credibility. Journal of Counseling & Development, 87, 311-318. doi: 10.1002/j.1556-6678.2009.tb00112.x

Reynolds, D. J., Jr., Stiles, W. B., & Grohol, J. M. (2006). An investigation of session impact and alliance in internet based psychotherapy: Preliminary results. Counselling & Psychotherapy Research, 6, 164-168.

Roberts, R. E. (1980). Reliability of the CES-D scale in different ethnic contexts. Psychiatry Research, 2, 125-134. doi: 10.1016/0165-1781(80)90069-4

Roberts, A. L., Gilman, S. E., Breslau, J., Breslau, N., & Koenen, K. C. (2011). Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Psychological Medicine, 41, 71–83. doi: 10.1017/S0033291710000401

Russell, R. R., Crimmings, A. M., & Lent, R. W. (1984). Therapist training and core components supervision: Theory and research. In J. S. Brown &R. W. Berry & D. L. Sam Lent (Eds.), The Cambridge Handbook of Counseling Psychology (pp. 11-26625–681). New York, NY: Wiley.

Sabnani, H. B., & Ponterotto, J. G. (1992). Racial/ethnic minority-specific instrumentation in counseling research: A review, critique, and recommendations. Measurement and Evaluation in Counseling and Development, 24, 161-187.

Santiago-Rivera, A. L., Stein, K. F., Keller, C., & Corte, C. (2014). Creando Posibilidades: A Cognitive Model of Risk Behaviors in Mexican American Women. Journal of Food and Nutritional Disorders, 3, 1-9.

Stiles, W. B. (1984). Client disclosure and psychotherapy session evaluations. British Journal of Clinical Psychology, 23, 311-312. doi: 10.1111/j.2044-8260.1984.tb01305.x

Stiles, W.B., & Snow, J.S. (1984a). Counseling session impact as viewed by novice counselors and their clients. Journal of Counseling Psychology, 31, 3-12. doi: 10.1037/0022-0167.31.1.3

Stiles, W.B., & Snow, J.S. (1984b). Dimensions of psychotherapy session impact across sessions and across clients. British Journal of Clinical Psychology, 23, 59-63. doi: j.2044-8260.1984.tb00627.x

Stiles, W.B., Reynolds, S., Hardy, G.E., Rees, A., Barkham, M., & Shapiro, D.A. (1994). Evaluation and description of psychotherapy sessions by clients using the session evaluation questionnaire and the session impacts scale. Journal of Counseling Psychology, 41, 175-185. doi: 10.1037/0022-0167.41.2.175

Stake, R.E. (2006). Multiple Case Study Analysis. New York: Guilford Press.

Sue, D.W., Arredondo, P., & McDavis, R.J. (1995). Multicultural counseling competencies and standards: A call to the profession. In J.G. Ponterotto, J.M. Casas, Suzuki, L.A., & Alexander, C.M. (Eds). Handbook of multicultural counseling (pp.624-644). Thousand Oaks: Sage.

Sue, D. W., & Sue, D. (2012). Counseling the culturally diverse: Theory and practice. Hoboken, NJ.: John Wiley & Sons.

Sue, S., Zane, N., Hall, G. C. N., & Berger, L. K. (2009). The case for cultural competency in psychotherapeutic interventions. Annual Review of Psychology,60, 525. doi: 10.1146/annurev.psych.60.110707.163651

Sundberg, N. D. (2013). Cross-cultural counseling and psychotherapy: A research overview. Cross-cultural counseling and psychotherapy, 28-62. doi: 10.1016/B978-0-08-025545-3.50007-7

Tracey, T.J., & Kokotovic, A.M. (1989). Factor structure of the Working Alliance Inventory. Psychological Assessment, 1, 207-210. doi: 10.1037/1040-3590.1.3.207

U.S. Census Bureau. (2011). Retrieved from

Whaley, A. L., & Davis, K. E. (2007). Cultural competence and evidence-based practice in mental health services: a complementary perspective. American Psychologist, 62(6), 563. doi: 10.1037/0003-066X.62.6.563

Vega, W. A., Kolody, B., Aguilar-Gaxiola, S., Alderete, E., Catalano, R., & Caraveo-Anduaga. (1998). Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California. Archives of General Psychiatry, 55, 771–778. doi: 10.1001/archpsyc.55.9.771

U.S. Census Bureau. (2013). American community survey. Retrieved June 26, 2015, from

Worthington, R. L., Mobley, M., Franks, R. P., & Tan, J. A. (2000). Multicultural counseling competencies: Verbal content, counselor attributions, and social desirability. Journal of Counseling Psychology, 47, 460-468. doi: 10.1037/0022-0167.47.4.460

Authors who publish with this journal agree to the following terms:

  1. Authors retain copyright and grant the journal right of first publication, with the work [SPECIFY PERIOD OF TIME] after publication simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
  2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
  3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).