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In this chapter, Ravind Jeawon and I discuss the ideas around being responsive to diversity in an evidence based manner. Although this chapter belongs within the evidence based responsiveness section discussed in the previous chapter, we both considered it essential to provide a whole chapter on its theory and application, as it is an integral area often overlooked in clinical training and provided a curtesy overview during ongoing professional development and clinical supervision. The multicultural literature uses different terminology to refer to the practice of responsiveness, we discuss these ideas and the evidence base for them, while introducing the reader to other processes and theories which will help developing practitioners make sense of what can be a vastly complex area of clinical work. Several adapted, real life case examples are drawn from Ravind’s clinical experience to encourage reflection and provide insight into these processes.

Organisations and systems of care working within both specific and non-specific trauma-informed approaches must adapt a multicultural lens, in design, delivery and evaluation of services and interventions. Cultural and social factors can directly influence the exposure of individuals to traumatic events (Roberts, Austin, Corliss, Vandermorris, & Koenen, 2010). At the same time, social and cultural identities influence the development and experience of trauma and symptoms, including treatment outcomes (Marsella, 2010; Wilson, 2007). In this chapter, Ravind Jeawon and I provide some of the essential factors that trauma-responsive systems may wish to consider. The first part of this chapter deals with the idea of multicultural identities and practices and highlights some of the outcomes associated with accessing behavioural healthcare. The impact of intersectionality and microaggression on those from diverse backgrounds is also considered. Finally, a guiding framework is provided that examines what needs to be implemented across organisations in order to provide the system with a multicultural lens in which to view and deliver appropriate services. Crucially, multicultural responsiveness will not come from tick box training regimes, it is something that needs to be kept on the agenda and is a lifelong trajectory.

The last chapter examined evidence based relationships from the perspective of emotional expression and the inner experience of the practitioner in relation to the client. In this chapter, I am introducing the first of a number of variables situated in evidence based relationships. Empathy, congruence, unconditional positive regard, and the real relationship will be discussed. I have chosen to categorise these four variables together due to their significant overlap and interaction with each other in terms of practice and research. This chapter does not attempt to provide an exhaustive description of each factor. Rather, I provide a very brief overview of the variable, provide an analysis of the research behind each, and highlight Top Tips that can guide the practitioner in their development.

Thus far, I have introduced the reader to evidence based practice in a broad sense, and evidence based relationships across important variables. In this chapter, I further build on this by extending the need for evidence based responsiveness as applied to client factors. While the practitioner brings themselves and their bag of tools to the therapy encounter, the client brings not just their presenting problem, but their characteristic way of thinking about their problems and how they manage distress and change. Therefore, the supportive practitioner will be best served to understand how these client factors manifest for each individual that they work with. The purpose of this chapter then, is to discuss coping style, reactant level, stage of change, attachment style, and client preferences, within the context of the practitioner being responsive to these factors as they impact on therapy outcomes.