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The different pathways chosen to efficiently and effectively provide relief to those struggling with mental health challenges reflect different assumptions about the human condition and have led to disagreements over which intervention strategies are best suited to particular individuals or populations. Evidence-based practice and culturally competent services, as discussed within the United States, have been characterized as opposites. However, neither approach captures all of the elements that embody the full treatment experience. This article offers a framework that includes the personal identity of the practitioner and the organizational context as two elements that serve as active agents in the helping relationship, although they have rarely been included in the discourse about evidence-based practice or cultural competence. Suggestions for practice, education, and research are included based on this analysis. [ABSTRACT FROM PUBLISHER]

Race enters into psychotherapy in ways that parallel its operation in society. This article offers in a 'narrative of race' an integrated model of psychological stress that is used as a guide in the biopsychosocial formulation of a case presentation. Negative internal models of relationships include that of the black matriarch, the emasculated black male, the white authority figure and the black self-rejected image. In the discussion of an African American patient in psychotherapy, we use these negative internal models to address two controversial issues. First, to what extent are racial conflict and negative internal models of relationships incorporated into the black patient's dysfunctional life issues? Second, can black patients resolve issues caused by their need to function in a racially stratified society through a therapeutic alliance with therapists from other cultures? We support the position of cross-race therapy dyads with the acknowledgment of race in the consultation room. African American patients can receive effective therapy from any culturally oriented therapist who facilitates the resolution of racial conflict. From this foundation, we propose a dynamic model in which the therapist enters the experience of the African American patient and establishes fixed points of reference for the proper detection of trans-ference/countertransference issues. [ABSTRACT FROM AUTHOR]